Gaps--anionic and osmolal
N. Smithline and K. D. Gardner Jr
Gaps is a bedside diagnostic game. It is played in two versions by
nephrologists. It deserves wider application by the practicing physician.
The more popular version, Anion Gaps, shows the presence of undetermined
anions and alerts the physician to the possibilities of laboratory error,
severe derangements in serum protein metabolism, or the ingestion of
certain ionic compounds that directly or indirectly alter the concentration
of routinely undetermined anions. A second version, Osmolal Gaps, shows the
presence of unmeasured osmoles or of increased plasma solids and can be
used in a variety of clinical situations to direct attention to laboratory,
error, hyperproteinemia, hyperlipidemia, or the presence of unmeasured
osmoles in the serum.
