Mildly Elevated Serum Anion Gap - why?

[MarkLA]

I'm hoping someone else has run into this...

Background:

Anion Gap (AG) is calculated. A high value indicates acidosis.

It is sometimes reported when you order a CMP, if not, it is easily calculated using the Sodium, Chloride and CO2 from the CMP with the following formula:

AG=NA - Chloride - CO2

For example from my most recent labs:

16=136 - 95 - 25

14 is the high end of the range and, so, 16 is elevated. Reviewing many articles there are many possible causes. Possible ones for me: side-effect of ketogenic diet (I eat very low carb), side-effect of anaerobic training, side-effect of arginine supplementation.

Any advice from those who may have run into the same thing would be much appreciated!

Mark


P.S. For purposes of completeness... It is "better" to adjust the AG by Albumin. The formula for that is:
Adjusted AG=AG+(2.5*(4-Albumin)) with my Albumin of 4.3, the Adjusted AG is 15.25 this tie.

 

[thatoneguy]

Mine has always been high usually at about 17.

I've always assumed this had to do with lactic acid from working out, the doctor has never addressed it so never really worried about it.

I'm curious to see what other say.

 

[MarkLA]

I made some progress on this and am updating the thread.

My diet is pretty clean with lots of vegetables and a medium amount of protein. The vegetables are alkaline and the protein is acidic.

I also drink a large amount of Coffee (very acidic) and distilled water (slightly acidic).

I obtained some Sodium Bicarbonate and some Potassium Bicarbonate and some pH strips. I found that adding 1/64 tsp of each (appx 75mg) of each to my mug of coffee would bring it so a pH of about 7.25. Likewise, by using 1/2 of that amount in water would likewise make it slightly alkaline.

I also slightly reduced my salt (sodium chloride) intake. Through my reading I found that excess sodium is excreted by the kidneys but that a small amount of calcium is required by that process which can eventually lead to demineralization over a long period of time. I figured good to take my salt intake from pretty high down to pretty medium for this reason as well as potential effect on the sodium part of the Anion Gap formula.

I did this for the last month or so and the result is an Anion Gap of 13 (down from 16).

AG=NA - Chloride - CO2
13=137 - 98 - 26


There is a caution that taking potassium can cause heart arrythmias or other heart issues if one is prone to those so it's worth researching and discussing with a Dr. (i.e. My experience is not a recommendation of you to go cause a heart attack!)

 

[thatoneguy]

Impressive you definitely did your homework on this. I've added more potassium into my diet, and have significantly lowered my coffee intake, unrelated to my aninon gap level. I guess next blood test I will see if it made any difference.

 

[MarkLA]

Cool, keep us in the loop.

WRT - Potassium (or Sodium). It's the Bicarbonate that's key to alkalinizing...