Decreased (< 6 mEq) Hypoalbuminemia (decreased unmeasured anion) Plasma cell dyscrasias Monoclonal protein (cationic paraprotein accompanied by chloride and bicarbonate) Bromide intoxication Increased (> 12 mEq) Metabolic anion Diabetic ketoacidosis Alcoholic ketoacidosis Lactic acidosis Chronic kidney disease (advanced stages) (PO43–, SO42–) Starvation Metabolic alkalosis (increased number of negative charges on protein) 5-oxoproline acidosis from acetaminophen toxicity Drug or chemical anion Salicylate intoxication Sodium carbenicillin therapy Methanol (formic acid) Ethylene glycol (oxalic acid) Normal (6–12 mEq) Loss of HCO3 Diarrhea Recovery from diabetic ketoacidosis Pancreatic fluid loss, ileostomy (unadapted) Carbonic anhydrase inhibitors Chloride retention Renal tubular acidosis Ileal loop bladder Administration of HCl equivalent or NH4Cl Arginine and lysine in parenteral nutrition |