What Are the Causes of a Low Anion Gap?

Anion gap, also known as anion gap (AG): refers to the difference between the concentration of unmeasured anions (UA) and unmeasured cations (UC) in plasma, that is, AG = UA-UC. Anion gap (AG): Refers to the difference between undetermined anion (UA) and undetermined cation (UC) in plasma. Because the total number of anions and cations in the extracellular fluid is equal, there are: measured cations (Na +) + unmeasured cations (UC) = measured anions (Cl- + HCO3-) + unmeasured anions (UA).

Anion gap

Clinical significance of anion gap

The AG value can be calculated clinically by using the measured values of the main anions and cations in the serum, which has certain value in the differential diagnosis of the etiology and type of metabolic acidosis. During the course of the disease, metabolic disorders and acidic products increase, leading to the most common symptoms of metabolic acidosis. Too much lactic acid is produced during hypoxia; patients cannot eat or suffer from metabolic disorders such as diabetes, which leads to an increase in ketone bodies; a large number of tissues such as bacteremia and burns, protein breakdown, resulting in an increase in sulfur products, etc. During the blood acid and alkali buffering process, HCO3- in the blood is consumed, and anions such as lactate, acetoacetate, and sulfate are increased. In order to maintain the balance of anion and cation, the body's change of Na and K and the increase of anionic acidic products will cause the transfer of Cl in the cell, reduce the sum of HCO3- and Cl in plasma, and increase the AG ratio.

The abnormality of the AG ratio can be manifested in two situations: increased and decreased. Clinically, the increase is more common and has greater clinical significance. AG elevation is more common in the entire process of metabolic acidosis:

When renal insufficiency causes azotemia or uremia, phosphate and sulfate storage occurs.

Severe hypoxemia, shock; tissue hypoxia, etc. cause lactic acid accumulation.

Hungry and diabetic patients use more fat to break down and build up ketone bodies.

From the analysis of AG, metabolic acidosis can be divided into high AG metabolic acidosis and AG normal metabolic acidosis (such as high blood Cl metabolic acidosis).

According to the level of AG, the cause of metabolic acidosis can be judged and it can be used as a reference for treatment. ^[1]

Anion Gap Food Therapy Analysis

1. High blood uric acid: kidney damage, too much purine-containing food.

Psyllium seed, sagebrush reduces uric acid, eat less broth, animal offal, thick chicken broth, sardines, dried small fish, anchovies, oysters and other high purine-containing foods.

2. High blood phosphorus: decreased kidney phosphorus excretion, renal failure, excessive intake of phosphorus-containing foods

Calcium supplement, adjust the ratio of calcium and phosphorus, daily phosphorus intake does not exceed the recommended amount of 700 mg, protect the kidneys, make phosphorus discharge normal, eat grains that contain phosphorus but are not easily absorbed and utilized.

3 Low anion gap: clinical manifestations of hypoalbuminemia due to intestinal loss, liver stiffness, splenomegaly, renal failure, insufficient liver synthesis, lymphatic obstruction, hyperthyroidism.

Supplemented with high-quality protein, Panax notoginseng and Salvia miltiorrhizas the liver and spleen, Prunella vulgaris and Didin promote lymphatic transformation.

4 Aspartate aminotransferase and alanine aminotransferase are high: tired, greasy, drugs, myocardial infarction, liver cirrhosis. Schisandra has reduced transaminase, eat less greasy and fatty.

5. High lactate dehydrogenase: myocardial infarction, muscular dystrophy, myocarditis, hemolytic anemia, liver cirrhosis

This is a glycolytic enzyme, raw ground, black ginseng, yam, Huang Jing, Astragalus, Atractylodes hypoglycemic.

6. High hydroxybutyrate dehydrogenase: excessive destruction of red blood cells, myocardial infarction.

Astragalus and jujube blood.

7. High phosphocreatine kinase isoenzyme: myocardial infarction, drugs

8. High total bile acid: slow liver damage, portal vein shorting (cause of bile reflux)

Cholestyramine inhibits bile acid absorption.

9. Low HDL: coronary heart disease

Supplement protein.

10 Neutropenia: hypersplenism, drug-induced, virus, typhoid

Supplement foods rich in niacin. Malt, barley kernel and spleen. Catalase-rich figs.

11. Lymphopenia: exposure to radiation, high corticosteroids; anti-radiation, spleen, kidney, and blood