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What is Increased anion gap seen in all EXCEPT and explain in detail?
(Renal tubular acidosis) (808-CMDT-10, 289-H17th)* Normal anion gap (AG) 6-12 mmol/L and is calculated as follows AG = Na+ - (Cl- + HCO3)ANION - GAP IN METABOLIC ACIDOSISNORMAL (6-12 mEq)INCREASED (>12mEq)* LossofHCOJ- Diarrhea**- Recovery from DKA- Pancreatic fluid loss ileostomy- Carbonic anhydrase inhibitors* Chloride retension- Renal tubular acidosis**- Ileal loop bladder* Administration of HC1 equivalent or NH4C1 Arginine and lysine in parenteral nutritionMetabolic anion**- DKA**- Alcoholic ketoacidosis- Lactic acidosis**- Chronic kidney disease (advanced stages)- Starvation- Metabolic alkolosis* Renal failure (Acute and chronic)Drugs or chemical anion- Salicylate intoxication- Sodium carbenicilline therapy- Methanol (formic acid)- Ethylene glycol (oxalic acid)**- Propylene glycol- Pyroglutamic acidDECREASED (<6 mEq)* Hypo albuminemia (decreased unmeasured anion)* Plasma cell dyscrasiasMonoclonal protein (cationic para protein) (accompanied by chloride and bicarbonate)* Bromide intoxication* It consist of for the most part of proteins in the anion form HPO 4 , SO 4 and organic acids. The unmeasured cations and K+, Ca+, or Mg+* Positive Urinary anion gap - Implies renal loss of bicarbonates and DX is usually distal RTA*** Negative urinary anion gap - Implies GI loss of bicarbonate - Diarrhea (Metabolic acidosis**)