METABOLIC ACIDOSIS: Normal Anion Gap Normal Anion Gap (<=14)(Loss of Bicarbonate) Elevated Anion Gap (>14) (Acid Gain) Renal Loss GI Tract Loss (Negative urine net charge) Indirect LossPositive U net chargeTTKG = (KUrine x OsmSerum)/(KSerum x OsmUrine) Urine net charge = UNa + UK - UClDirect Loss Negative U net charge High FEHCO3 History of diarrhea? Principal Cell Problem Low TTKG?- Intercalated Cell ProblemHigh TTKG Diarrhea Fistula RTA Type II Carbonic anhydrase inhibitor RTA Type IV RTA Type I Metabolic Acidosis Need to correct anion gap for albumin: For every drop of 10 for albumin (from 40) add 2.5 to the anion gap

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