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- It is the sum of unmeasured anions in the serum (phosphates,
sulfates, ketons, proteins,organic acids) determined
by subtracting the sum of measured anions: (Na +
K) - (HCO3 + Cl)
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- 10-15 mEq/L or 10-15 µmol/L
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- To distinguish the causes of metabolic
acidosis
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- Hypernatremia
- Hyperosmolar Coma
- Hypocalcemia
- Hypomagnesemia
- Ketoacidosis
- Lactic acidosis
- Starvation
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- Hypercalcemia
- Hypermagnesemia
- Hypoalbuminemia
- Hyponatremia
- Multiple myeloma
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- Dehydration
- Ingestion of licorice
- Ethylene glycol
- Methanol
- Paraldehyde
- Salicylates
- Medications
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