Acid Base Disorders - The Anion Gap (Equation, Physiology, Applications, Differential Diagnoses)

This is video 4 of our 5 video series on Acid-Base Disorders. In this video we dive into the anion gap. We start by discussing what the anion gap is and why it is important for Acid-Base Disorders. We then cover the components of the anion gap including sodium, potassium, bicarbonate, and chloride. And the unmeasured cations and anions. We cover albumin's role in correcting the anion gap equation. We use the physiology of an anion gap to understand why a high anion gap (HAGMA) has a different differential diagnosis than a Non-anion gap (NAGMA). We do a deep dive on the differential diagnoses including mnemonics to better remember, such as GOLDMARKS, MUDPILES, and more.
Please check out our Acid-Base Disorders series linked below!
(1) Acid Base Disorders - Introduction (Definitions, Buffering Systems, And More) Explained Clearly: • Acid Base Disorders - ...
(2) Acid Based Disorders - Metabolic Vs Respiratory, Kidney And Lungs, Equations, Primary Disorders: • Acid Based Disorders -...
(3) Acid Base Disorders - Metabolic Vs Respiratory, Compensation, Acute Vs Chronic Explained Clearly: • Acid Base Disorders - ...
(4) Acid Base Disorders - The Anion Gap (Equation, Physiology, Applications, Differential Diagnoses): • Acid Base Disorders - ...
(5) Acid Base Disorders - Delta Delta, Delta Gap, Delta Ratio (Explained Clearly!): • Acid Base Disorders -...
Comprehensive overview:
• Acid Base Disorders - ...
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[@davidmbeckmann]

Good video. Many, many years ago, a Nephrologist, now long dead, told me to always calculate the anion gap as the first step of blood gas analysis, as a good anion gap means metabolic acidosis, which may not be readily apparent in a mixed disturbance.

[@christianwong91]

Can you explain how excessive IVNS causes a NAGMA? I understand the IVNS components are 154 meq of Na/Cl, and the increase in Cl would cause your HCO3 to drop in compensation, but I can't seem to connect that with a change in pH. Shouldn't that Cl increase to HCO3 decrease still result in a normal pH? Or is it because bicarb is more negatively charged than chloride which results in eventual acidemia due to the bicarb loss?