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Important aspects of diarrhoea management. Country Index.. Author Index.. Quick Menu.. Back Issues Menu.. These terms are used here as though they were synonymous. This is mostly true, but if hyponatraemia is present the plasma [Cl - ] may be normal despite the presence of a normal anion gap acidosis. This could be considered a ' relative hyperchloraemia '.
However, you should be aware that in some cases of normal anion-gap acidosis, there will not be a hyperchloraemia if there is a significant hyponatraemia. The anion gap may still be within the reference range in lactic acidosis.
Now this can be misleading to you when you are trying to diagnose the disorder. Once you note the presence of an anion gap within the reference range in a patient with a metabolic acidosis you naturally tend to concentrate on looking for a renal or GIT cause. One possibility is the increase in anions may be too low to push the anion gap out of the reference range.
So the causes of high anion gap acidosis should be considered in patients with hyperchloraemic acidosis if the cause of the acidosis is otherwise not apparent.
Administration of IV saline solution may replace lost acid anion with chloride so that treatment may result in the acidosis converting to a hyperchloraemic type. In lactic acidosis, the movement of lactate intracellularly in exchange for chloride occurs via an antiport. So if we find a hyperchloraemic component this clearly suggests that the lactate is being taken up by some cells in exchange for chloride. This movement of the acid anion intracellularly is one mechanism responsible for a hyperchloraemic component in some types of high anion gap acidosis.
This could result in a situation where the anion gap is only elevated slightly or still within the normal range due to the combination of small errors in the measurement of the component electrolytes. Some of the causes are listed in the Table in Section 5.
Renal tubular acidosis is discussed in the next section. A review of these causes shows that the predominant mechanism is loss of base bicarbonate or bicarbonate precursors and this may occur by either GIT or renal mechanisms.
A gain of acid can occur with certain infusions but this situation can be diagnosed easily on history. In general then the diagnosis of a normal anion gap acidosis is just to look for evidence of one of only two mechanisms:. Disorders of acid-base balance. Brenner and Rector's The Kidney. Philadelphia, PA: Elsevier; chap Palmer BF. Metabolic acidosis. Comprehensive Clinical Nephrology. Seifter JL. Acid-base disorders. Goldman-Cecil Medicine. Updated by: David C. Editorial team. Metabolic acidosis is a condition in which there is too much acid in the body fluids.
Disorders of acid-base balance. Brenner and Rector's The Kidney. Philadelphia, PA: Elsevier; chap Palmer BF. Metabolic acidosis. Comprehensive Clinical Nephrology. Seifter JL. Acid-base disorders. Goldman-Cecil Medicine. URAC's accreditation program is the first of its kind, requiring compliance with 53 standards of quality and accountability, verified by independent audit. Learn more about A.
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