YAOUNDE, Cameroon -
Dec. 26, 2020 -
PRLog -- It is routine practice to measure only four charged particles, i.e., sodium, potassium, chloride and bicarbonate ions. When the number of cations (Na+ and K+) are added, one will always find that they outnumber the anions (Cl- and HCO3-). The calculated difference is what is foreshadowed by the term Anion Gap (AG) — which reflects the unmeasured anions. Since there are more unmeasured anions (albumin, phosphate, and lactate) than unmeasured cations (calcium, magnesium, and potassium), the value of the AG is usually positive. Metabolic acidosis is the most common cause of raised anion gap. The reliability of the AG has been questioned due to its underestimation in patients with hypoalbuminemia, which is a frequent occurrence in critically ill patients. Correction of the AG for serum albumin improves the accuracy of this parameter. As a whole, an extreme elevation in the AG requires the presence of renal failure, hemoconcentration, and increases in serum phosphorus and albumin concentrations. Metabolic acidosis may be associated to elevated tissue acids (mainly lactate and/or unmeasured anions), hyperchloremia, or a combination of both. The Cl-Na ratio and albumin are usually low in the presence of tissue acids, and hence could be used as alternatives (i.e., to the AG) in identifying raised tissue acids. It is hypothesized that metabolic acidosis associated with a rise in tissue acids, is accompanied by a decrease in plasma chloride (Cl) relative to sodium (Na). Therefore, a Cl-Na ratio <0.75 is a good predictor of increased tissue acids, whereas a high ratio (>0.79) excludes the presence of raised tissue acids. In conclusion, a Cl-Na ratio >0.79 has an acidifying effect on plasma, while a Cl-Na ratio <0.75 has an alkalinizing effect.
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