CLINICAL CASE 52: ANSWERS and SUMMARY

TRUE OR FALSE: SEVERE METABOLIC OR RESPIRATORY ALKALOSIS CAN LEAD TO AN ANION GAP METABOLIC ACIDOSIS.

True 60%

False 40%

Severe alkalemia can cause an increase in anion gap.  Alkalemia leads to glycolysis in the liver and a mild lactic acidosis. In severe volume contracted state, the anion gap can be seen with change in valence of circulating proteins to preserve extracellular volume.  

A prior post had discussed this as well. 

See the references below:

Emmett M, Narins R. Clinical use of the anion gap. Medicine 1977; 56:38–45.

Kraut J, Madias N. Serum anion gap: its uses and limitations in clinical medicine. Clin J Am Soc Nephrol 2007; 2: 162–174.