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Strong ion gap: A methodology for exploring unexplained anions

Kellum, JA and Kramer, DJ and Pinsky, MR (1995) Strong ion gap: A methodology for exploring unexplained anions. Journal of Critical Care, 10 (2). 51 - 55. ISSN 0883-9441

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Purpose: This paper describes the calculation of the strong ion gap (SIG), a physical chemical methodology similar to the anion gap (AG), as a measure of the anion/cation balance exclusive of sodium, potassium, chloride, and bicarbonate. We compared the SIG and AG methodologies in three groups of subjects with and without unexplained anions. These groups were (1) healthy volunteers with hyperlacticemia during exercise; (2) intensive care unit (ICU) patients with sepsis; and (3) ICU patients with severe liver disease. Methods: The SIG, AG, and corrected AG (AGc) were calculated for each group from data available in the original reports (groups 1 and 2) and by retrospective chart review (group 3). Results: The SIG correlated poorly with the AG in group 2, whereas no correlation was seen in groups 1 and 3. The AGc correlated with SIG in all three groups (r = .99, .93, and .91 respectively; P < .01 for each group). Although the AG was similar, the SIG differed for each group. Group 1 had levels of SIG near zero, and groups 2 and 3 had mean SIG's of 4.80 ± 4.67 mEq/L and 9.60 ± 6.43 mEq/L respectively. The composition of the anion gap differed markedly among subject types. Conclusions: The SIG correlates with the AG once corrected for all known anions. The SIG technique can detect unknown anions in a patient population known to have them and does not detect unknown anions in healthy volunteers during exercise. This test detects large amounts of unknown anions in some patients with sepsis or liver disease. Therefore, the test is both sensitive and specific in characterizing metabolic acidosis. © 1995.


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Item Type: Article
Status: Published
CreatorsEmailPitt UsernameORCID
Kellum, JAkellum@pitt.eduKELLUM0000-0003-1995-2653
Kramer, DJ
Pinsky, MRpinsky@pitt.eduPINSKY0000-0001-6166-700X
Date: 1 January 1995
Date Type: Publication
Journal or Publication Title: Journal of Critical Care
Volume: 10
Number: 2
Page Range: 51 - 55
DOI or Unique Handle: 10.1016/0883-9441(95)90016-0
Schools and Programs: School of Medicine > Critical Care Medicine
Refereed: Yes
ISSN: 0883-9441
PubMed ID: 7647842
Date Deposited: 05 Mar 2012 17:11
Last Modified: 30 Jan 2020 16:55


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