acidosis regardless of the pH or the serum 1 3 concentration. The anion gap may be artificially lowered by decreased serum albumin, multiple myeloma, lithium intoxication, or a profound increase in the serum potassium, calcium, or magnesi-um.11

Step 4 in Figure 28-1 shows how calculation of the anion gap also facilitates determination of the excess gap or the degree to which the calculated anion gap exceeds the normal anion gap. The excess gap is calculated as follows:

Excess gap = anion gap - 12 = [Na+ - (CP + '"'CO} )] - 12.

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