To detect a problem with the body's electrolyte balance.
Electrolytes and Anion Gap
As part of routine blood testing, or when your doctor suspects that you have an imbalance of one of the electrolytes (usually sodium or potassium), or if your doctor suspects an acid-base imbalance. Electrolytes may also be checked if you are prescribed certain drugs, particularly diuretics or ACE inhibitors.
A blood sample taken from a vein in the arm or in some cases, a urine sample
None
-
How is it used?
Electrolyte measurements are used to screen for an electrolyte or pH imbalance and to monitor the effect of treatment on a known imbalance that is affecting bodily organ function. Since electrolytes are often abnormal in a variety of acute (short term) and chronic (long term) illnesses, they are frequently requested in hospitalised patients.
-
When is it requested?
It may be requested as part of routine testing or as a diagnostic aid for a specific disease, such as oedema (too much water in tissues) or cardiac arrhythmias. If one or more of the electrolytes is imbalanced, your doctor may want to monitor that individual electrolyte closely while treating the cause of the imbalance.
-
What does the test result mean?
Electrolyte levels are affected by how much is taken in through your diet, the amount of water in your body, and the quantity of electrolytes excreted by your kidneys. They are also affected by hormones, especially aldosterone, a hormone that retains sodium in the body but increases the loss of potassium via the kidney.
In specific disorders, one or more electrolytes may be abnormal. Your healthcare professional will look at the overall balance but is likely to be especially concerned with your sodium and potassium concentration. People whose kidneys are not functioning properly, for example, may retain excess fluid in the body, diluting the sodium and chloride so that they fall below normal concentrations. Those who experience severe fluid loss may show an increase in potassium, sodium, and chloride concentration (chloride tends to mirror the sodium concentration). Some forms of heart disease, muscle and nerve problems, and diabetes may also have one or more abnormal electrolytes. Electrolyte abnormalities may also be a consequence of drug treatment.
Knowing which electrolytes are out of balance can help your healthcare professional determine the cause and treatment to restore proper balance. If left untreated, electrolyte imbalance can lead to dizziness, cramps, irregular heartbeat, and possibly death.
Test results are reported as a numerical value and must be compared with an appropriate reference range in order to determine the significance of the result. Reference ranges may vary for a variety of reasons including the patient's age and sex, as well as the instrumentation or kit used to perform the test. To learn more about reference ranges, please see the article, Reference Ranges and What They Mean. Your local laboratory will advise your healthcare professional of the appropriate reference range for your particular test.
-
Is there anything else I should know?
Depending on which electrolyte(s) is out of balance and the extent of that change, treatment may involve changing your diet, for example to lower salt intake, increasing or reducing fluid intake, or taking or stopping medication such as diuretics. Once treatment has begun, you may be asked to have regular testing to determine how well the treatment has worked and to make sure the imbalance does not reoccur.
-
What is anion gap?
The Anion gap (AG) is a value calculated using the results of an electrolyte panel. It estimates the difference (gap) between the measured positively charged ions (called cations) and the measured negatively charged ions (called anions) in the fluid portion of blood (serum or plasma).
The most commonly used formula is:
Anion Gap = Sodium - (Chloride + bicarbonate)
Note sodium (Na+) is the main cation measured in blood and chloride (Cl-) and bicarbonate (HCO3-) are the main anions measured.
The number of positive ions (cations) and negative ions (anions) must be equal (cancel each other out) to maintain electrical neutrality of the blood. However, not all ions are routinely measured. The calculated AG result represents the unmeasured ions and primarily consists of anions, hence the name “anion gap”.
If the anion gap is higher than expected (i.e. the number of unmeasured anions is increased) it indicates the unusual presence of an excess of an anion in the blood. Examples are ketones (in uncontrolled diabetes or starvation), sulphates, phosphates and organic acids (in kidney disease or damage), and other organic acids such as oxalate or glycolate (resulting from the ingestion of potentially toxic substances such as antifreeze or methanol or excessive amounts of aspirin).
It is used to help distinguish between anion-gap and non-anion-gap metabolic acidosis. Acidosis refers to an excess of acid in the body; this can disturb many cell functions and should be recognised as quickly as possible, when present.
The metabolic acidosis must be treated to restore the acid/base balance, but the underlying condition must also be identified and treated. If anion-gap metabolic acidosis is identified, the AG may be used to help monitor the effectiveness of treatment and the underlying condition.
AG is frequently used in the hospital and/or accident and emergency room setting to help diagnose and monitor acutely ill patients. A low anion gap can also occur; this is most commonly seen when albumin (an anion as well as a protein) is low, while immunoglobulins (cations as well as proteins) are increased.
Note, there are other AG formulas (some include the potassium (K+) concentration to estimate cation concentration), so reference ranges are not interchangeable. Each laboratory formula will have an established normal range that should be referenced.