Anion gap physiology and faults of the correction formula

2021 ◽  
Author(s):  
Andrew K Posen ◽  
Frank P Paloucek ◽  
Renee Petzel Gimbar
Keyword(s):  
Clinical Trials ◽  
Human Physiology ◽  
Diagnostic Yield ◽  
Laboratory Parameter ◽  
Anion Gap ◽  
Acid Base ◽  
Final Version ◽  
Correction Formula ◽  
Final Article ◽  
Missed Diagnoses

Abstract Disclaimer In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose The anion gap is a calculated fundamental laboratory parameter used to identify and monitor acid-base disturbances. A recently popularized correction formula transforms the resulting integer to compensate for hypoalbuminemia and improve diagnostic yield. Clinical pharmacists should be aware of the underlying biochemistry, interpretation, and limitations of this formula to discern drug- and disease-related etiologies. Summary The anion gap is utilized in most care settings, ranging from outpatient monitoring to inpatient intensive care units. Supported by decades of experience, the original anion gap derives its value from its simplicity. Applying the anion gap in metabolic acidosis can help narrow differential diagnosis and detect concomitant acid-base disorders. To account for hypoalbuminemia and potential missed diagnoses, a correction formula was developed to improve sensitivity. Yet, the law of electroneutrality ensures that hypoalbuminemia is already accounted for in the original anion gap, and the proposed correction formula was derived from samples unrepresentative of human physiology. Evidence from clinical trials shows no benefit from applying the correction formula. Conclusion There is no advantage to correcting the anion gap, and such correction may increase the risk of misinterpretation or error. Clinicians should understand these limitations when diagnosing or trending acid-base disturbances.

Hypochloremia in cats – prevalence and associated diseases

2016 ◽  
Vol 44 (04) ◽  
pp. 237-244 ◽  
Author(s):  
Maximilian Pagitz ◽  
Mona Sarah Friedrich ◽  
Florian K. Zeugswetter
Keyword(s):  
Diabetes Mellitus ◽  
Medical Records ◽  
Inverse Correlation ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Anion Gap ◽  
Control Group ◽  
Blood Gas ◽  
Acid Base ◽  
Correction Formula

SummaryObjective: To describe the prevalence and possible causes of hypochloremia in the local hospital cat population. Material and methods: Retrospective study consisting of two parts. Data were collected from the local electronic medical records database using the search terms „chloride“ and „cats“ (part A), and „blood gas analysis“ and „cats“ (part B). The medical records of the hypochloremic cats were then reviewed to determine prior treatment or infusions and to identify major underlying disease processes. Part A included an age and gender matched non-hypochloremic control group, whereas in part B acid-base status was assessed. Results: Hypochloremia was detected in 367 (27%) of 1363 blood samples. The application of a correction formula to adjust for free water changes decreased the number of hypochloremic cats to 253 (19%). Only a minority had received glucocorticoids or loop diuretics and the prevalence of vomiting was 44%. Common associated disorders were gastrointestinal and respiratory diseases, as well as azotemia and diabetes mellitus. Polyuria/ polydipsia, dehydration, prednisolone or furosemide pretreatment, azotemia and diabetes mellitus increased, whereas fluid therapy and the diagnosis of neoplasia decreased the prevalence of hypochloremia. An inverse correlation was found between corrected chloride and standar dized base excess (rs = –0.597, p = 0.001) as well as anion gap (rs = –0.4, p = 0.026). 99% of the hypochloremic cats had derangements of acid-base balance. Conclusion: Hypochloremia is a common electrolyte disorder in the local cat population. The correction formula is ne cessary to adjust for changes in plasma osmolality. Although associated with metabolic alkalosis, most of the hypochloremic cats have a normal or decreased pH. The inverse correlation of chloride and anion gap als well as the high proportion of azotemic or diabetic animals support the concept of compensatory acidosis induced hypochlor emia. Clinical relevance: Hypochloremia should prompt the clinician to performe blood-gas analysis. Diabetes mellitus (especially ketoacidosis) and renal disease should be included in current algorithms for the evaluation of hypochloremic patients.

The need for increased education and training of pharmacy learners in the care of older, critically ill, and end-of-life patients

2021 ◽  
Author(s):  
Marianne F Ivey ◽  
Tyler A Vest ◽  
David A Zilz
Keyword(s):  
End Of Life ◽  
Critically Ill ◽  
Education And Training ◽  
Final Version ◽  
Final Article ◽  
And Training

Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

Teaching residents how to deliver active learning during didactic lectures

2021 ◽  
Author(s):  
Jamie L Miller ◽  
Katy Stephens ◽  
Peter N Johnson ◽  
Melissa Medina
Keyword(s):  
Active Learning ◽  
Final Version ◽  
Final Article

Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

The pharmacist as provocateur

2021 ◽  
Author(s):  
Tom Woller
Keyword(s):  
Final Version ◽  
Final Article

Disclaimer In an effort to expedite the publication of articles , AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

scholarly journals Optimizing student pharmacists’ contributions to patient care during a pandemic

2021 ◽  
Author(s):  
Jill T Robke ◽  
Hannah Niss ◽  
T Mark Woods
Keyword(s):  
Patient Care ◽  
Final Version ◽  
Final Article

Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

scholarly journals The economic opportunity of departmental training during pandemic scenarios: Concepts and analyses

2021 ◽  
Author(s):  
Nicholas Trombold ◽  
Dima Awad
Keyword(s):  
Economic Opportunity ◽  
Final Version ◽  
Final Article

Disclaimer In an effort to expedite the publication of articles , AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

The essential nature of and continued need for health systems to prioritize the medication-use process

2021 ◽  
Author(s):  
Tyler A Vest ◽  
Nicholas P Gazda ◽  
Stephen F Eckel
Keyword(s):  
Health Systems ◽  
Medication Use ◽  
Final Version ◽  
Essential Nature ◽  
Final Article

Disclaimer In an effort to expedite the publication of articles , AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

Ethics in Clinical Studies: The Dilemma of very Young and Old

2021 ◽  
Vol 3 (2) ◽  
Author(s):  
Avisek Dutta ◽  
Avisek Dutta ◽  
Avisek Dutta
Keyword(s):  
Clinical Trial ◽  
Clinical Trials ◽  
Human Physiology ◽  
Informed Consent ◽  
Adverse Effects ◽  
Age Groups ◽  
The Elderly ◽  
Infantile Spasms ◽  
Care Givers ◽  
Improve Health

The objectives of the research are to percolate knowledge which can improve health and improve understanding of human physiology. Pervasive exclusion of children and elderly in clinical trials as is happening today is not justified. Children have different physiology and pharmacology from adults; often adverse effects are also different and specific. Diseases like neonatal hyperbilirubinemia, infantile spasms are very age specific. Elderly too, have age specific issues like dementias, malignancies, weakened systems and polypharmacy that make them a special cohort. Clinical trials in these age groups are essential so as to gather comprehensive data about a medication across all age groups. Informed consent is a challenge in both these groups. It can be remedied by obtaining consent from parents, or legally acceptable representative in case of children and care givers and/or LARs in case of the elderly. Oral assent from 7 to 11 years, and written assent from 12 to 18 years and in the elderly, along with consent from the LAR, parents, care givers as the case may be, forms the bedrock of good clinical trial ethics.

Sign in / Sign up

Export Citation Format

Share Document