Low anion gap

Angio gap

1. negative anion gap

2. other
anions
Cl
HCO3
other
cations
Na
AnionsCations=
Gamblegram

3. THE ANION GAP
other
anions
Cl
HCO3
other
cations
Na
AnionsCations=
Cl + HCO3 + other anionsNa + other cations=
Cl + HCO3 + other anions – other cationsNa=
other anions – other cationsNa – (Cl + HCO3)=
THE ANION GAP
the anion gap

4. THE ANION GAPother
anions
Cl
HCO3
other
cations
Na
AnionsCations=
other anions – other cationsNa – (Cl + HCO3)=
Occurs with metabolic
acidosis
Addition of exogenous or
endogenous acids
G glycols
O oxoproline
L l-lactic acid
D d-lactic acid
M methanol
A aspirin
R renal failure
K ketones
Increased “other anions” 

Could theoretically occur with
decreased “other cations”
THE ANION GAP
increased anion gap

5. THE ANION GAPother
anions
Cl
HCO3
other
cations
Na
AnionsCations=
other anions – other cationsNa – (Cl + HCO3)=
Occurs due to
decreased anions
Albumin
Proteins
Phosphorus
Sulfates
IgA
THE 

ANION
GAP
Due to increased
cations
Potassium
Calcium
Magnesium
Lithium
IgG
Bromide
decreased anion gap

9. Sodium 128
Potassium 4.7
Chloride 97
Carbon dioxide 32
Glucose 103
Osmolality 303
anion gap -1