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The Low Anion Gap

Albert A. Keshgegian, MD, PhD
JAMA. 1980;244(18):2047-2048. doi:10.1001/jama.1980.03310180017019.
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To the Editor.—  The article by Goldstein et al on the anion gap provides a comprehensive summary of the range of anion gap in a hospitalized population, but some of the conclusions that the authors draw may not necessarily be justified by the data.The authors assembled the data on anion gap in a large number of hospitalized patients, obtained a mean ±2 SDs, assumed that values below this range are low, and found only a few patients with a low anion gap. However, the appropriate comparison would have been with the range of anion gap found in a healthy population. A number of studies have shown that the range found in a healthy population is narrower than the range found in hospitalized patients (as reviewed by Witte et al1). It is obvious that the high values in hospital patients will include those in renal failure and other forms


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