Elevated Anion

Normal Anion Gap0

.M—.Methanol metformin U—Uremia

D—Diabetic (or alcoholic}

ketoacidosis ?—Paraldehyde, phenformin I—]soniajidr iron L—Lactic acidosis F—Fthylene glycol ethanol S—Salicylates

U—Ureteral diversion S—Saline infusion £—Foogenous acid D—Diarrhea C—Carbonic anhydrase inhibitors A—Adrenal insufficiency R—RenaE tubular acidosis dAnion gap = serurm sodiunn concentration - {serum chloride concentration + serum bicarbonate concentration). Under normal circumstances, the anion gap should be 10 m£q/L (mmol/L) or less.

In summary, the approach to assessment of acid-base status involves four key steps as outlined in Figure 28-1: Step 1—initial inspection of the pH, PaCO2, and

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