A 67-year-old man arrives in the emergency department complaining of fatigue, co

Question

A 67-year-old man arrives in the emergency department complaining of fatigue, confusion, headache, and loss of appetite. When you take his medical history, he reveals that he has advanced renal disease and recently missed a dialysis appointment. You order a basic metabolic panel and an arterial blood gas. These tests reveal the following pertinent values:

A 67-year-old man arrives in the emergency department complaining of fatigue, confusion, headache, and loss of appetite. When you take his medical history, he reveals that he has advanced renal disease and recently missed a dialysis appointment. You order a basic metabolic panel and an arterial blood gas. These tests reveal the following pertinent values: pH = 7.22 PCO2-23 mEq/L PO2 = 98 mEq/L HCO3 10 mEq/L Na+ 140 mEq/L K" = 5.0 mEq/L Cl-110mEq/L The patient's anion gap is mEq/L 45

Explanation / Answer

Anion gap can be considered as the difference between the primarily measured cations and the anions. The cations include sodium and potassium and the anions include chlorides and bicarbonate ions.

Anion gap calculation is preferred when a patient is suspected with the Renal failure, illness etc.

The value of anion gap more than 20mEq/L is seen in conditions like Metabolic acidosis, renal failure, Uremia etc.

Serum anion gap is calculated to identify the conditions like metabolic acidosis .Formula to calculate serum anion gap is Serum anion gap = (Na+K) - ( Cl+HCO3)

Serum anion gap is used to identity acid base disorders, multiple myelomas etc.

Hence from the above results the serum anion gap can be considered as (140 + 5 ) - ( 110+10)

Then the answer would be 145-120 = 25 mEq

But the anion gap used to differentiate cations and anions in urine is by the use of formula ,

Urine anion gap = (Na+ K) - (Cl)

Urine anion gap is calculated for those who are having renal disorders.

So the Urine anion gap would be( 140 + 5 ) - 110 = 35mEq/L

In urine anion gap calculation, bicarbonate ions are not taken in to consideration because the urine is acidic in nature and the value of bicarbonate is negligible.

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