DiNubile M J
UMDNJ/Robert Wood Johnson Medical School, Camden.
Lancet. 1988 Oct 22;2(8617):951-3. doi: 10.1016/s0140-6736(88)92610-4.
The calculation of the anion gap is widely used in the diagnosis of metabolic acidosis. It is often taught that the increment in the anion gap will exactly match the fall in serum bicarbonate during a simple metabolic acidosis of the high anion gap type; if the changes in the anion gap and bicarbonate level are not equivalent, a second acid-base disorder should be suspected. The assumptions upon which this formulation is based are largely unsubstantiated. This review critically examines these assumptions and their clinical implications. Discrepancies between the increment in the anion gap and the reduction in serum bicarbonate must be interpreted cautiously.
阴离子间隙的计算在代谢性酸中毒的诊断中被广泛应用。人们通常认为，在高阴离子间隙型单纯代谢性酸中毒期间，阴离子间隙的增加将与血清碳酸氢盐的下降完全匹配；如果阴离子间隙和碳酸氢盐水平的变化不相等，则应怀疑存在第二种酸碱紊乱。该公式所基于的假设在很大程度上未经证实。本综述批判性地审视了这些假设及其临床意义。阴离子间隙增加与血清碳酸氢盐减少之间的差异必须谨慎解释。
