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Cleveland Clinic Journal of Medicine

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Review

Evaluating a low anion gap: A practical approach

Lawrence A. Haber, MD, Gurpreet Dhaliwal, MD, Lowell Lo, MD and Gabrielle Rizzuto, MD, PhD
Cleveland Clinic Journal of Medicine October 2023, 90 (10) 619-623; DOI: https://doi.org/10.3949/ccjm.90a.23035
Lawrence A. Haber
Department of Medicine, Division of Hospital Medicine, Denver Health and Hospital Authority, University of Colorado, Denver, CO
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  • For correspondence: [email protected]
Gurpreet Dhaliwal
Medical Service, VA San Francisco Healthcare System, San Francisco, CA; Department of Medicine, University of California San Francisco, San Francisco, CA
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Lowell Lo
Department of Medicine, Division of Nephrology, University of California San Francisco, San Francisco, CA
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Gabrielle Rizzuto
Human Oncology and Pathogenesis Program, Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
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ABSTRACT

In teaching and in practice, little attention is given to a low anion gap. This oversight can result in a missed opportunity to diagnose acute or chronic disorders requiring treatment. In this article, we review the constituents of the anion gap, build a differential diagnosis for a low anion gap using case examples, and provide a stepwise approach to diagnostic testing to evaluate this abnormal finding.

  • Copyright © 2023 The Cleveland Clinic Foundation. All Rights Reserved.
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  1. Lawrence A. Haber, MD⇑
  1. Department of Medicine, Division of Hospital Medicine, Denver Health and Hospital Authority, University of Colorado, Denver, CO
  1. Address:
    Lawrence A. Haber, MD, Department of Medicine, Division of Hospital Medicine, Denver Health and Hospital Authority, 777 Bannock Street, Denver, CO 80204; lawrence.haber{at}dhha.org
  1. Gurpreet Dhaliwal, MD
  1. Medical Service, VA San Francisco Healthcare System, San Francisco, CA; Department of Medicine, University of California San Francisco, San Francisco, CA
  1. Lowell Lo, MD
  1. Department of Medicine, Division of Nephrology, University of California San Francisco, San Francisco, CA
  1. Gabrielle Rizzuto, MD, PhD
  1. Human Oncology and Pathogenesis Program, Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY

ABSTRACT

In teaching and in practice, little attention is given to a low anion gap. This oversight can result in a missed opportunity to diagnose acute or chronic disorders requiring treatment. In this article, we review the constituents of the anion gap, build a differential diagnosis for a low anion gap using case examples, and provide a stepwise approach to diagnostic testing to evaluate this abnormal finding.

  • Copyright © 2023 The Cleveland Clinic Foundation. All Rights Reserved.
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Cleveland Clinic Journal of Medicine: 90 (10)
Cleveland Clinic Journal of Medicine
Vol. 90, Issue 10
1 Oct 2023
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Evaluating a low anion gap: A practical approach
Lawrence A. Haber, Gurpreet Dhaliwal, Lowell Lo, Gabrielle Rizzuto
Cleveland Clinic Journal of Medicine Oct 2023, 90 (10) 619-623; DOI: 10.3949/ccjm.90a.23035

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Evaluating a low anion gap: A practical approach
Lawrence A. Haber, Gurpreet Dhaliwal, Lowell Lo, Gabrielle Rizzuto
Cleveland Clinic Journal of Medicine Oct 2023, 90 (10) 619-623; DOI: 10.3949/ccjm.90a.23035
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  • Article
    • ABSTRACT
    • WHAT MAKES UP THE ANION GAP?
    • HOW LOW IS TOO LOW?
    • CAUSES OF A LOW ANION GAP: CASE SCENARIOS
    • AN APPROACH FOR CLINICIANS
    • DISCLOSURES
    • Acknowledgment
    • REFERENCES
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