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Anion Gap Calculation and Differential
- Calculate the anion gap with this formula: sodium - bicarbonate - chloride.
- If elevated, consider the mnemonic "KULT": ketones, uremia, lactate, toxins.
Causes of Elevated Anion Gap
- Evaluate for ketoacidosis (diabetic, alcoholic, starvation), uremia (GFR < 20-30), and lactate (type A and B).
- Consider rarer causes like toxins (e.g., metformin, propylene glycol) and other metabolic issues.
Elevated Anion Gap Workup
- For an elevated anion gap, repeat electrolytes, check lactate and ketones, and consider a toxicology screen.
- This helps determine the cause quickly and efficiently.