End
Serum Anion Gap
Evaluates states of metabolic acidosis. Useful to determine if a patient’s metabolic acidosis has an elevated anion gap. Automatically calculates albumin correction and delta ratio.
Sodium (Na⁺)
mEq/L
Chloride (Cl⁻)
mEq/L
Bicarbonate (HCO₃⁻)
mEq/L
Albumin (Optional)
Patients with low albumin may have a lower baseline anion gap. Correction is recommended.
g/dL
—
Anion Gap
(mEq/L)
(mEq/L)
Albumin Corrected AG
—
Delta Gap (ΔAG)
—
Delta Ratio (ΔAG/ΔHCO₃)
—
| Delta Ratio | Suggests… |
|---|---|
| < 0.4 | Pure normal anion gap acidosis (Hyperchloremic) |
| 0.4 – 0.8 | Mixed high and normal anion gap acidosis |
| 0.8 – 2.0 | Pure anion gap acidosis |
| > 2.0 | High anion gap acidosis with pre-existing metabolic alkalosis |
Anion Gap Metabolic Acidosis (MUDPILERS)
- Methanol
- Uremia
- Diabetic ketoacidosis / alcoholic ketoacidosis
- Paraldehyde
- Isoniazid
- Lactic acidosis
- Ethanol / ethylene glycol
- Rhabdomyolysis / renal failure
- Salicylates
Non-Anion Gap Acidosis (HARDUPS)
- Hyperalimentation
- Acetazolamide
- Renal tubular acidosis
- Diarrhea
- Ureteroenterostomy (or fistula)
- Post-hypocapnia
- Spironolactone
Metabolic Alkalosis (CLEVER PD)
- Contraction
- Licorice
- Endocrine (Conn’s, Cushings, Bartter’s)
- Vomiting
- Excess alkali
- Refeeding alkalosis
- Post-hypercapnia
- Diuretics
Respiratory Alkalosis (CHAMPS) – Speed up breathing
- CNS disease
- Hypoxia
- Anxiety
- Mechanical ventilators
- Progesterone
- Salicylates / sepsis
