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March 26, 1982

Hypoalbuminemia and Decreased Anion Gap

JAMA. 1982;247(12):1697-1698. doi:10.1001/jama.1982.03320370015015

To the Editor.—  The article by Nanji et al (1981;246:859) described an association between hypoalbuminemic states and a decreased anion gap, presumably owing to a decrease in unmeasured anionic albumin. However, there is no significant correlation between the individual albumin concentrations and degree of decrease in the anion gap. One would expect, if the decrease in the anion gap were directly related to the low albumin concentration, that lower albumin concentrations would be associated with lower anion gaps. In other protein disorders, such as monoclonal gammopathy in multiple myeloma1,2 and polyclonal gammopathy in various diseases,3,4 an association between the quantitative level of abnormal protein and the effect on the anion gap has been shown.The authors do not report the relationship of total protein concentration and anion gap, even though in most of the hypoalbuminemic groups the total protein concentration would also be expected to be low (eg,