The Cardiovascular
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Urine anion gap

Distinguishes renal from GI causes of normal-anion-gap metabolic acidosis.

Urine anion gap
Urine sodium
mEq/L
Urine potassium
mEq/L
Urine chloride
mEq/L
Complete the fields above to see the result.

When to use

  • Evaluating a normal-anion-gap (hyperchloraemic) metabolic acidosis to separate renal tubular acidosis from gastrointestinal bicarbonate loss.

Formula

Urine anion gap = urine Na⁺ + urine K⁺ − urine Cl⁻. A useful mnemonic: a neGUTive gap points to the gut (diarrhoea).

Pearls and pitfalls

  • The gap is an indirect estimate of urinary ammonium; it is unreliable when the urine contains other unmeasured anions (e.g. ketones, hippurate in toluene toxicity).

References

  1. Goldstein MB, et al. The urine anion gap: a clinically useful index of ammonium excretion. Am J Med Sci. 1986;292(4):198–202.