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Low Anion Gap
I just had blood work done on 09/11/2023. Basic Metabolic Panel. The one that concerned me was Anion Gap. The normal range is 7-13. Mine was 6. On August 24, 2023, 18 days earlier, it was 11. My Anion Gap dropped 5 numbers. I contacted my Doctor with my rightful concerns, hence it is considered "Very rare" to have a below normal Anion Gap. My Doctor was quite "Nonchalant" and told me this it is "Normal" and numbers can slightly fluctuate and "Not to worry", well, I am and that is no small fluctuation! **Mayo claims IF your Anion Gap is "Below normal", your doctor should order a re-test to rule out "Lab error". She did NOT even consider this! I asked her to do a re-test to rule out any disease or cancer, if she doesn't, I may call the Supervisor of the Clinic. I have to literally beg. Your thoughts or opinions would be great. If a hematologist see's this post, I would like your opinion.
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Hi @sallylynn, Blood numbers can fluctuate readily even during any given day.
If you were to have your numbers checked daily you’d see a wide range of fluctuation in the numbers. I had a bone marrow transplant where I had 2 or more sets of blood work done daily. It was fascinating to see the range of numbers change within the day depending on my hydration and med intakes.
There’s really no universal “normal” anion gap because labs and healthcare providers measuring the numbers may have different reference ranges for a normal anion gap. I notice a difference between the parameters set by my Mayo lab and my local hospital.
The anion gap is a calculation of the difference between the amounts of some negatively charged electrolytes (such as chloride and bicarbonate) and the amount of positively charged electrolytes (such as sodium) in your blood.
That can vary by the amount of hydration in your body, foods you eat, medications, health of kidney, liver, etc.. Reading through some past replies, I see you have kidney disease. Were you told to avoid excess protein? The most common cause of a low anion gap is a low level of albumin, a protein in the blood. Eating more protein can help raise that level of albumin. But I realize that may be a fine line for you.
Doctors look for trends in blood results. Your doctor isn’t doing a knee jerk reaction to your blood work because everything else seems to be looking good…not flagged. So this could be a one-off event. More concerning would be a too high anion reading. A little more than 2 weeks ago your numbers were fine so unless your doctor sees a downward trend she’s not sensing anything alarming. What was your albumin number? If it was ok, then your doctor will expect this low anion number wasn’t significant.
When is your next set of labs?
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2 ReactionsThank you so much for responding~ I really appreciate it. I should mention my Creatinine was .095 (Normal) on Aug.24, and on Sept. 11 it was 1.05, a bit over average. My eGFR was 68 on Aug.24, and dropped to 60 on Sept.11.- On August 24 my Albumin was 3.6(Normal) my Platelets were 227(Normal) My WBC was 3.6(Below Average). My Red Cell Count was 4.1M/ul(Normal). These are my Anion Gap numbers of recent, starting from most recent: 6,11,11,11,8,7,9,12,11,11.
So, too see 6 was shocking. Nothing has changed in my intake of Protein. The only thing I am doing different now is taking vitamin B12 500mcg per day. I should mention on July 26, out of no where, I developed a neuropathy. Two days later, my ankle bones were aching. I was diagnosed with neuropathy. They gave me Gabapentin. I only took it for 3 days. I started taking B12. My B12 labs were in normal but very low at 268 where the normal low range is 213. My neuropathy got better for awhile, feeling hopeful, but now again my hands tingle, my arms, and body sometimes and I do feel bone pain on and off in my lower legs and ankles. It wakes me up at night. I guess that is why I am worried now with the low Anion Gap. I just find it odd with all those Anion Gaps in the normal range, why it dropped so suddenly. ~ Any advise would be great. Thank you.
She has not set up any labs. I did request a re-check of my Anion Gap hence even Mayo and Hopkins recommends the Doctor do a re-check to rule out "Lab error". I have not heard form her as of yet.
My doctor had the same demeanor. I also had a high potasium level and he had me get another blood test that day. It proved to be normal. No one really cared about the anion gap number but when I go back in January and if it is low, I will bring this up again.
My doctors are hard to read...sometimes.
Cindy
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1 ReactionHi Cindy. I had an appt. with my Doctor on Sept. 18. I still don't know why I have bone pain & nephropathy. She STILL REFUSED TO DO A RE-CHECK! She said that frequent "Blood work" causes stress. I AM CHANGING DOCTORS! She actually told me that I don't have cancer (Multiple Meyloma) and how she can help me get that idea out of my head. No blood tests to back this up!!!!!!!!!!! She is a 4th year Resident. I was assigned her because my clinic is a teaching clinic.* The reason I am worried IS because MM is related to a LOW Anion Gap.
I am calling my Clinic tomorrow and getting a new Doctor with more years of experience. I mean, I pray I am OK, but, well, I am worried & she knows it. I feel like a poodle in a pink skirt jumping through the flaming hoop. I am glad Cindy your potassium was ok. ~
Wow. Shocking. Yes, you need a different doctor. Really scary she denies
condition. I don't 't get that at all. Keep us all posted and good luck! It
seems many I met have been forced into getting new doctors. Please get the
bone pain checked.
Cindy
Hi Cindy. For 2 months I have been telling her this, the bone pain with neuropathy. I have intentionally leaving all my symptoms on my My Chart, leaving a digital paper trail. I even documented that she told me I do not have cancer, because if I do, it is documented what she said and refused to do a re-check of my BMP. I even told the ER on July 26, they ran all the blood work, said I was fine. Went back to ER on Aug.24 with same complaint, actually started weeping, they ran the blood work, said it all looked great, the only exception was my WBC were lower at 3.6. Sept.11 I went to my clinic for a BMP and my Anion Gap was 6. My Calcium was 10 which is very close to being over the range. I feel at this point I am just in a bad dream. SOMETHING is causing this & they are not concerned, you would think they would be concerned with a patient with bone pain, but, they are not. Just so you know, a new report came out recently and it is scary shocking: 7.4 million patients are misdiagnosed of the 130 million annual visits to ERs. The number translates to about 1 in 18 people receiving a wrong diagnosis. 2.6 million patients receive a harm that could have been prevented. Misdiagnosis of disease or other medical conditions leads to hundreds of thousands of deaths and permanent disabilities each year in the United States, according to a report published this week.
About 371,000 people die and 424,000 sustain permanent disabilities – such as brain damage, blindness, loss of limbs or organs or metastasized cancer – each year as a result.
Look at those numbers! This is just the USA alone!
With misdiagnosis that touched my Family memebers personally, and now with my current situation, it is very east to mistrust and second guess a doctor.
“These are relatively common diseases that are missed relatively commonly and are associated with significant amounts of harm,” said Dr. David Newman-Toker, a neurologist at Johns Hopkins University. He led the study’s research team from the Johns Hopkins Armstrong Institute Center for Diagnostic Excellence, in partnership with researchers from the Risk Management Foundation of Harvard Medical Institutions Inc.
I understand. I hardly ever think this or say this but in your case. , you really do need to see another doctor. Sounds just awful.
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1 ReactionHi Sally, your bloodwork is similar to mine. I have hyperparathyroidism although my insurance is denying treatment.
Read this article from the world leading Norman Parathyroid Center in Tampa Florida. Request a PTH assay from your doctor. Hyperparathyroidism can be caused by kidney disfunction and/or calcium malabsorption issues such as severe gut dysbiosis. Hyperparathyroidism can also lead to kidney failure if left untreated.
To aid your kidneys I recommend taking Standard Process Renafood with bovine PMG (a type of peptide), it has helped me to recover 10% of my kidney function.
Aloha, Phil.
Ok, as a new member it is not permitting me to add a link. Find the Norman Parathyroid Center website and open the article called 'How to Diagnose Hyperparathyroidism '.