Rachana
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Can somebody please explain gap/non gap acidosis?
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| rida
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Sorry for the stupid question, but are you asking about anion gap acidosis???
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| Idiopathic
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When acid is added/produced by the body, bicarbonate must be lost. If an acid is added (i.e. lactic acid, formic acid), then the bocarbonate is lost and the charge differential is balanced by the deprotonated acid (negative charge). This is an increased AG acidosis (normochloremic). When pure bicarbonate is lost (i.e. with acetazolamide Rx), then the charge is balanced out by Cl- retention, and you have a normal AG acidosis (hyperchloremic).
The AG is figured by: serum Na - (serum Cl + serum HCO3)
If that number is over 12-14 (different sources say different things), then you have incraesed AG acidosis, and acids are being added to the body somehow (even lactate from underperfusion is considered added tp the body).
Hope this helps.
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| Rachana
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Yes Rida thats what I meant.
Thanks idiopathic. Its not very clear to me as yet...maybe I'll have to read more abt it.
Thanks anyways...
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| rida
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This is what it is basically, in your serum you have all kinds of molecules, Na, Cl, HCO3 that we tend to measure in different situations. Well aside from these, there are also other anions (negatively charged ) in our serum that we dont normally take into account. These include phosphate, citrate, sulfate, and proteins. If HCO3 ever decreases, one of these anions would have to increase to maintain electroneurality and replace the lost HCO3. That anion can be Cl or any of the others i mentioned, like phosphate, sulfate protein etc. In metabolic acidosis, you most definetely have a decrease in HCO3, therefore, when you test the serum of the patient, you have to figure out the concentration of the anions that might be there, and if they are increased you know for sure that there is a metabolic acidosis. Normal anion gap is 8 - 12, and if this is increased, that just means that a concentration of an anion aside from Chlorine has been increased, but if its normal, then that means that Chlorine has been increased, so it just measures those other anions. Hope this helps and i didn't confuse you further.
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| Rachana
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Thanks Rida....
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| phenobarbiedoll
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Rachana, do you have the book BRS Physio? Looking at Figure 5-22 may help if you are a visual person. Basically in the picture there is a colum on the left where you see cations (Na+). There's a column on the right, where you see three groups of anions (Cl-, HCO3-, and Anion gap). The column on the left and the column on the right must equal each other, for electroneutrality's sake.
As rida explained, HCO3- will be depleted any time you have acidosis. Mainly because it is used to buffer the acid.
So if you imagine the picture of anions on the right column, you have to replace anions somehow in order to keep that side balanced with the cations (Na+) on the other side of the picture.
So the types of acidosis you asked about: 1) (Increased) Serum anion gap acidosis: just imagine the anion gap group grows bigger to replace the lost HCO3- group. 2) Normal acidosis (serum gap not increased; hyperchloremic metabolic acidosis): imagine the Cl- group grows bigger to replace the lost HCO3- group.
I know this is just the same thing people already explained above, but thought I'd try to help too 
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| rida
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Thanx for the explanation phenobarbiedoll, i am glad you explained it in your way too because maybe someone would understand that better.
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