JDM  Vol.5 No.4 , November 2015
Relationship between Serum Anion Gap and Diabetes Mellitus
Abstract: Diabetes mellitus is the most common metabolic disorder occasioned by derangement in glucose equilibration between the ECF and ICF. The derangement is known to affect the appropriate balance of electrolytes that serves as a buffer in the body. In this study anion gap was evaluated among outpatient diabetics as compared to non-diabetics control group. The categorization into the study or control groups was done by serum glucose estimation using glucose oxidase method. The study group mean age was 51 ±14 as against control group of 47 ± 10. One hundred and fifty subjects were divided in two groups based on serum glucose concentration. Group A (control group) consisted of 50 subjects with mean serum glucose concentration 4.3 ±1.7 mmol/l and anion gap 13.8 ± 2.6, group B (diabetics) consisted of 100 subjects that had serum glucose concentration 15.0 ± 3.9 and anion gap 18.4 ± 2.5. The glucose was estimation by glucose oxidase method, whereas the anion gap was calculated by subtracting the concentrations of sodium and potassium from the concentrations of chloride and bicarbonate. The concentrations of the electrolytes where assayed using ion selective electrodes (ISE). A statistical significant difference P < 0.05 was observed between group A and B glucose concentrations and the anion gap. The abnormal anion gap was created by the insufficiency of bicarbonate used for the buffering of the electrolytes variability occasioned by derangement in glucose metabolism and distorted hormonal secretion. Hence metabolic acidosis is strongly linked with diabetics as a result of distorted anion gap. Healthcare providers and takers should ensure that anion gap estimation is factored into investigations for the management of diabetics. Also, patients with deranged anion gap should be placed as an emergency case for proper management. Clinicians should ensure that patient’s anion gap is within the reference anion gap range so as to prevent development into metabolic acidosis and subsequent ketoacidosis.
Cite this paper: Solomon, A. , Wankasi, M. and Ileimokumo, O. (2015) Relationship between Serum Anion Gap and Diabetes Mellitus. Journal of Diabetes Mellitus, 5, 199-205. doi: 10.4236/jdm.2015.54024.

[1]   Gabow, P.A., Kaehny, W.D., Fennessey, P.V., et al. (1980) Diagnostic Importance of an Increased Serum Anion Gap. The New England Journal of Medicine, 303, 854-858.

[2]   Witte, D.L., Rodgers, J.L. and Barrett, D.A. (1976) Anion Gap: Its Use in Quality-Control. Clinical Chemistry, 22, 643-646.

[3]   Murray, T., Long, W. and Narins, R.G. (1975). Multiple Myeloma and Anion Gap. The New England Journal of Medicine, 292, 574-575.

[4]   Paladini, G. and Sala, P.G. (1979) Anion Gap in Multiple Myeloma. Acta Haematologica, 62, 148-152.

[5]   Kelleher, S.P., Raciti, A. and Arbeit, L.A. (1986) Reduced or Absent Serum Anion Gap as a Marker of Severe Lithium Carbonate Intoxication. Archives of Internal Medicine, 146, 1839-1840.

[6]   Wacks, I., Oster, J.R., Perez, G.O. and Kett, D.H. (1990) Spurious Hyperchloremia and Hyperbicarbonatemia in a Patient Receiving Pyridostigmine Bromide Therapy for Myasthenia Gravis. American Journal of Kidney Diseases, 16, 76-79.

[7]   Fischman, R.A., Fairclough, G.F. and Cheigh, J.S. (1978) Iodide and Negative Anion Gap. The New England Journal of Medicine, 298, 1035-1036.

[8]   Mehta, A.N., Emmett, J.B. and Emmett, M. ( 2008) GOLD MARK: An Anion Gap Mnemonic for the 21st Century. The Lancet, 372, 892.

[9]   Feldman, M., Soni, N. and Dickson, B. (2005) Influence of Hypoalbuminemia or Hyperalbuminemia on the Serum Anion Gap. The Journal of Laboratory and Clinical Medicine, 146, 14.

[10]   Lolekha, P.H. and Lolekha, S. (1983) Value of the Anion Gap in Clinical Diagnosis and Laboratory Evaluation. Clinical Chemistry, 29, 279-283.

[11]   Farwell, W.R. and Taylor, E.N. (2008) Serum Bicarbonate, Anion Gap and Insulin Resistance in the National Health and Nutrition Examination Survey. Diabetic Medicine, 25, 798-804.

[12]   Paulson, W.D. (1986) Anion Gap-Bicaronate in Diabetic Ketoacidosis. American Journal of Medicine, 81, 798-804.

[13]   Kraut, J.A. and Madias, N.E. (2007) Serum Anion Gap: Its Uses and Limitations in Clinical Medicine. Clinical Journal of the American Society of Nephrology, 2, 162-174.

[14]   Qujeq, D. and Mohiti, J. (2002) Decreased Anion Gap in Polyclonal Hypergammaglobulinemia. Clinical Biochemistry, 35, 73-75.