Anion Gap Acidosis

Published

Can someone please explain the difference btwn non-anion and anion met acidosis, why it's important to know the difference and how do we treat/manage this? I just started in ICU and I have been hearing this a lot here.

Up Vote Up Vote ×
Specializes in Med/Surg, Ortho, ASC.

Have you researched this at all on the internet or in your textbooks? If you're a nurse, then you really should know how to research anything you're confused about.

Rather than ask someone to take the time to teach you the basics, why not read up on the basics and then come with specific questions?

Up Vote Up Vote ×
Specializes in Family Nurse Practitioner.

It depends on how messed up your electrolytes and bicarb are. There's a formula out there. A wide gap is bad. By correcting the acidoses and dehydration and fixing electrolyte issues you close the gap and balance the equation.

Up Vote Up Vote ×
Specializes in Nursey stuff.

Maybe this will help some.

Anion gap is a further step to figure out why a person has for instance, in this case, metabolic acidosis. I like to pretend it's a mystery… obtain objective and subjective information.

Patient is a 65 year old male admitted with moderate dehydration, and complaint of diarrhea for the last 3 days.

Okay lets draw labs, and get a blood gas… Na+ 134, K+ 2.9, Cl- 108, HCO3- 16, BUN 31,

Cr 1.5.

First figure out your blood gas/ ph = 7.32, CO2 = 34 HCO3= 15 (metabolic acidosis)

I am thinking this is due to his history of diarrhea and the loss of bicarbonate because, the most common etiology of normal anion gap acidosis is diarrhea with renal tubular acidosis being a distant second

Know your parameters –Normal is 6-12 mEq/L (non anion is another way of saying it)

Get familiar with what they could indicate

Low – (

Normal – (6-12) Hyperalimentation, Acetazolamide and other carbonic anhydrase inhibitors, Renal tubular acidosis, Diarrhea, Ureteroenteric fistula - an abnormal connection (fistula) between a ureter and the gastrointestinal tract, Pancreaticoduodenal fistula - an abnormal connection between the pancreas and duodenum (HARDUP)

High (>12) Methanol, Uremia, Diabetic ketoacidosis, Paraldehyde, Alcohol, Lactic acidosis, Ethylene glycol, Salicylate toxicity( MUDPALES)

Okay, with that understood, lets calculate the anion gap… basically subtracting negative (anions) from positive (cations). K+ doesn't do much in this case so we drop it.

Na - (Cl + HCO3-) = 134 - (108 + 16) = 10 this is the gap! :) Woo hoo and it's WNL! Good for me, cause I was right, but bad for him, cause his elytes are crappy. The treatment is based on the underlying etiology, and I would suggest sooner than later in this case.

Up Vote Up Vote ×

thanks everyone else for the help especially ladyscrubs :)

Up Vote Up Vote ×
Specializes in ER, Trauma, ICU, CVICU, EP.

Keep asking questions. We all do not grasp everything simply by reading the research. That's why we need people who can teach. Glad that you got the answer that you needed....

Here's a link - I love this website for breaking down complex issues

Normal Anion Gap Metabolic Acidosis

Up Vote Up Vote ×
Have you researched this at all on the internet or in your textbooks? If you're a nurse, then you really should know how to research anything you're confused about.

Rather than ask someone to take the time to teach you the basics, why not read up on the basics and then come with specific questions?

If you don't know the answer, just don't say anything.

Up Vote Up Vote ×
Specializes in ICU.

@roser13:

Way to treat and beat down the desire to learn and good intentions. No offense but nurses like you make young nurses miserable. Why don't you just not answer if you don't want to?! This is a forum for exactly those kinds of questions.

Go take a mentor class. It will be good for ya.

Up Vote Up Vote ×
Maybe this will help some.

"Anion gap is a further step to figure out why a person has for instance, in this case, metabolic acidosis. I like to pretend it's a mystery… obtain objective and subjective information. Just like in nursing school, and I bet you never thought you would use it :woot:."

Very nice answer!!! Helpful, informative, not condescending.....I bet you are a great teacher, Ladyscrubs!!!(Sorry, my quote feature didn't work right. Again.)

Up Vote Up Vote ×
@roser13:

Way to treat and beat down the desire to learn and good intentions. No offense but nurses like you make young nurses miserable. Why don't you just not answer if you don't want to?! This is a forum for exactly those kinds of questions.

Go take a mentor class. It will be good for ya.

Well said!

Up Vote Up Vote ×
Specializes in Nurse Anesthesiology.

You all beat this guy up for simply stating the obvious. The OP asked a question and even said how they've heard this a lot but NOT ONE time did they say they looked up anything. They came here and asked a question a VERY simple google search would result in 100 pages of info that would explain this concept to them.

I think it's a very valid question to the OP that they research this. Now if the OP came here and asked "hey I looked up anion gap and have a few questions about x y z" then sure I don't see a problem with that, but they didn't do that. Telling the person to actually do some simple research is not "eating their young." Its acting like a professional and being able to think for yourself and not just getting someone else to give you the answer because you don't feel like looking up something yourself.

Have you researched this at all on the internet or in your textbooks? If you're a nurse, then you really should know how to research anything you're confused about.

Rather than ask someone to take the time to teach you the basics, why not read up on the basics and then come with specific questions?

Up Vote Up Vote ×
Specializes in PMHNP.

Maybe the OP was trying to seek out nurses who have experience with this phenomenon on a daily basis as they are adjusting to their role as an ICU nurse. Just think! All that time you spent writing your sassy reply you could have spent...gasp!...helping another nurse? See the problem?

You all beat this guy up for simply stating the obvious. The OP asked a question and even said how they've heard this a lot but NOT ONE time did they say they looked up anything. They came here and asked a question a VERY simple google search would result in 100 pages of info that would explain this concept to them.

I think it's a very valid question to the OP that they research this. Now if the OP came here and asked "hey I looked up anion gap and have a few questions about x y z" then sure I don't see a problem with that, but they didn't do that. Telling the person to actually do some simple research is not "eating their young." Its acting like a professional and being able to think for yourself and not just getting someone else to give you the answer because you don't feel like looking up something yourself.

Up Vote Up Vote ×
+ Join the Discussion