Calculators & Tools

Anion Gap Calculator

Na − (Cl + HCO₃)

1 What is the Anion Gap Calculator?

The Anion Gap Calculator computes the serum anion gap from sodium, bicarbonate, and chloride using AG = Na⁺ − (HCO₃⁻ + Cl⁻). The app's own reference card cites a normal anion gap of 10–12 mEq/L, while noting many labs use a wider 8–16 mEq/L range. It then bands the result into low, normal, mild-high, and high categories, each linked to a differential diagnosis to guide the work-up of metabolic acidosis.

2 When to use it

  • Working up a patient with metabolic acidosis (low serum bicarbonate) to distinguish high-anion-gap from normal-anion-gap causes
  • Screening for toxic ingestions (e.g. salicylates, methanol, ethylene glycol) when a high anion gap is unexplained
  • Evaluating suspected diabetic ketoacidosis or other ketoacidosis states
  • Assessing unexplained acidosis in a critically ill or dehydrated child
  • Distinguishing renal tubular acidosis and GI bicarbonate loss (normal-gap picture) from high-gap processes
  • Deciding whether the anion gap should be corrected for albumin, since hypoalbuminaemia is flagged as the most common cause of a low anion gap

3 Formula & method

AG = Na⁺ − (HCO₃⁻ + Cl⁻), as shown on the app's result card. The header reference states a normal range of 10–12 mEq/L (noting many labs use 8–16 mEq/L). The app bands the computed result as: below 8 mEq/L (low), 8–12 mEq/L (normal), 12–20 mEq/L (mild high), and above 20 mEq/L (high) — the last labelled a significant high-anion-gap metabolic acidosis and linked to the MUDPILES differential (methanol, uraemia, DKA/other ketoacidosis, paracetamol/propylene glycol, iron/INH, lactic acidosis, ethylene glycol, salicylates).
  • Harriet Lane 23rd ed.
  • Nelson 21st ed.

4 Frequently asked questions

What formula does the Anion Gap Calculator use?

It calculates AG = Na⁺ − (HCO₃⁻ + Cl⁻) from serum sodium, bicarbonate, and chloride, per the app's result card.

What is considered a normal anion gap in this tool?

The app's reference card lists a normal anion gap of 10–12 mEq/L, while noting many labs use a wider 8–16 mEq/L range; its own interpretation bands treat 8–12 mEq/L as normal.

What causes a high anion gap?

The app flags anion gaps above 20 mEq/L as a significant high-anion-gap metabolic acidosis and lists the MUDPILES mnemonic (methanol, uraemia, DKA/ketoacidosis, paracetamol/propylene glycol, iron/INH, lactic acidosis, ethylene glycol, salicylates) as the differential.

What causes a low anion gap?

The tool lists hypoalbuminaemia as the most common cause, along with bromism, lithium toxicity, hypercalcaemia, and multiple myeloma, and recommends correcting the AG for albumin when albumin is low.

Where do the interpretation bands come from?

The app states its interpretation bands are drawn from the Harriet Lane Handbook (23rd edition) and Nelson Textbook of Pediatrics (21st edition).

For qualified clinicians. This page and the PediAid app are a clinical aid only. Calculations and reference data must be verified against the patient's clinical context, the source guideline and your local protocols before any treatment decision is made.