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Values for different ions are given different in different sources. Since anion gap is calculated from those values, even the value of the anion gap will come out to be different. However, physiologically, the anion gap has a range between 8 and 16 mEq/L, with a mean value of 12 mEq/L.
Thank you sir for the explanation, thus I have 2 questions: 1) The AG remains normal only when the additional acid is HCl otherwise the AG will increase right? 2) Can we use the same formula for alkalosis (most unmeasured ions are cations) ?
1. Yes. If it’s HCl, the anion gap will remain normal, else it will increase. So, basically, we first measure these cations and anions. From their values, we calculate anion gap. If it has increased, it tells us that there is metabolic acidosis. 2. The formula is meant to detect acidosis (and that too, metabolic acidosis, such as lactic acidosis or ketoacidosis). It is not meant to detect alkalosis. It’s basically the decrease in HCO3- that widens the anion gap. Decrease in HCO3- occurs in acidosis.
@@VivekSirsPhysiology would anion gap decrease in metabolic alkalosis because bicarbonate conc increase and increase bicarbonate will react with acids of unmeasured anions?
It is to diagnose the metabolic acidosis, the anion gap is useful. Basically, there are two components of the Henderson Hasselbach equation - CO2 and HCO3-. With a simple lab investigation, we get the serum levels of electrolytes (Na+, Cl-, HCO3-, and K+ and others; we consider the first 3 mentioned here, though.) HCO3- is the alkali which, if decreases, would clearly indicate about the METABOLIC acidosis. And, this would be confirmed by the increased anion gap. The respiratory component in the acid-base balance is CO2. We do not measure CO2. Thus, respiratory acid-base disorder can not be diagnosed by the anion gap calculation.
Cynthia Oliver Since it is about the plasma, the main cations & anions in plasma should be considered (i.e., with high concentrations). So, the cation is Na+ and anions are Cl- and HCO3-. The gap between these will be 12 mEq/L. +/- 4 is for the K+ (K+ concentration in plasma). Why +/- 4 ? It is because we are essentially trying to find out METABOLIC ACIDOSIS, while calculating anion gap. Acidosis means generation of H+. These H+ come out of cells into the plasma , in metabolic acidosis. Now, due to H+/K+-ATPase, H+ and K+ move in opposite directions (if H+ comes out of cells, K+ from plasma will be pushed into cells). Thus, the window of +/- 4 mEq/L is kept in calculation of anion gap, so as to take into account the possible movement of K+.
Sir if reabsorption of water from dct and ct is facultative and happens only on action of ADH and we say aldosterone causes reabsorption of sodium from dct and ct and water follows so aldosterone helps in equal reabsorption of water sodium. So sir if reabsorption of water from ct and dct happens only on action of adh then how come when aldosterone causes reabsorption of sodium does water follow? Isnt dct and ct impermeable for water without adh? Sir I know this question is unrelated with anion gap topic sir but please reply..
The simple answer is - how the movement of water occurs? First of all, even in complete absence of ADH , 88% of the filtered water is still reabsorbed from different segments of the nephron. So, ADH is not absolutely necessary for water reabsorption. Second, ADH causes water movement through special channels called aquaporins. However, in the absence of ADH and aquaporins also, the water can be reabsorbed. How? Mostly it moves by osmosis. And that’s what happens in the case of aldosterone action. As Na+ is moved (reabsorbed), it creates that osmotic gradient for water reabsorption. This can occur anywhere, including the collecting duct.
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Lucidly explained the most confusing topic of ACID BASE BALANCE. Thanks a million, Sir.
Thank you for nice explanation.
Different places show different values of anion gap. Please tell physiological value in range for anion gap.
Thanks in advance.
Values for different ions are given different in different sources. Since anion gap is calculated from those values, even the value of the anion gap will come out to be different. However, physiologically, the anion gap has a range between 8 and 16 mEq/L, with a mean value of 12 mEq/L.
Great
Awesome sir🔥
Sanskriti Chandak Thanks!
Crystal clear concept
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Stay Strong Thanks for the comment!
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Thank you sir for the explanation, thus I have 2 questions:
1) The AG remains normal only when the additional acid is HCl otherwise the AG will increase right?
2) Can we use the same formula for alkalosis (most unmeasured ions are cations) ?
1. Yes. If it’s HCl, the anion gap will remain normal, else it will increase. So, basically, we first measure these cations and anions. From their values, we calculate anion gap. If it has increased, it tells us that there is metabolic acidosis.
2. The formula is meant to detect acidosis (and that too, metabolic acidosis, such as lactic acidosis or ketoacidosis). It is not meant to detect alkalosis. It’s basically the decrease in HCO3- that widens the anion gap. Decrease in HCO3- occurs in acidosis.
@@VivekSirsPhysiology would anion gap decrease in metabolic alkalosis because bicarbonate conc increase and increase bicarbonate will react with acids of unmeasured anions?
Can anion gap increase or decrease in respiratory acidosis or alkalosis? Why do we consider this only for metabolic acidosis?
It is to diagnose the metabolic acidosis, the anion gap is useful. Basically, there are two components of the Henderson Hasselbach equation - CO2 and HCO3-. With a simple lab investigation, we get the serum levels of electrolytes (Na+, Cl-, HCO3-, and K+ and others; we consider the first 3 mentioned here, though.) HCO3- is the alkali which, if decreases, would clearly indicate about the METABOLIC acidosis. And, this would be confirmed by the increased anion gap. The respiratory component in the acid-base balance is CO2. We do not measure CO2. Thus, respiratory acid-base disorder can not be diagnosed by the anion gap calculation.
Great video. Thank you so much...but wat does d plus or minus 4 mean? Does it mean wen potassium is added and subtracted respectively??
Cynthia Oliver Since it is about the plasma, the main cations & anions in plasma should be considered (i.e., with high concentrations). So, the cation is Na+ and anions are Cl- and HCO3-. The gap between these will be 12 mEq/L. +/- 4 is for the K+ (K+ concentration in plasma). Why +/- 4 ? It is because we are essentially trying to find out METABOLIC ACIDOSIS, while calculating anion gap. Acidosis means generation of H+. These H+ come out of cells into the plasma , in metabolic acidosis. Now, due to H+/K+-ATPase, H+ and K+ move in opposite directions (if H+ comes out of cells, K+ from plasma will be pushed into cells). Thus, the window of +/- 4 mEq/L is kept in calculation of anion gap, so as to take into account the possible movement of K+.
Thank u soooo much sir! I now understand...ur really great!!!
@@VivekSirsPhysiology What a concept. Thanks sir.
100% clear 😀
Sir if reabsorption of water from dct and ct is facultative and happens only on action of ADH and we say aldosterone causes reabsorption of sodium from dct and ct and water follows so aldosterone helps in equal reabsorption of water sodium. So sir if reabsorption of water from ct and dct happens only on action of adh then how come when aldosterone causes reabsorption of sodium does water follow? Isnt dct and ct impermeable for water without adh? Sir I know this question is unrelated with anion gap topic sir but please reply..
The simple answer is - how the movement of water occurs? First of all, even in complete absence of ADH , 88% of the filtered water is still reabsorbed from different segments of the nephron. So, ADH is not absolutely necessary for water reabsorption. Second, ADH causes water movement through special channels called aquaporins. However, in the absence of ADH and aquaporins also, the water can be reabsorbed. How? Mostly it moves by osmosis. And that’s what happens in the case of aldosterone action. As Na+ is moved (reabsorbed), it creates that osmotic gradient for water reabsorption. This can occur anywhere, including the collecting duct.
@@VivekSirsPhysiology Thank you so much sir🙏🙏🙏
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