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March 26, 1982

Hypoalbuminemia and Decreased Anion Gap-Reply

JAMA. 1982;247(12):1698. doi:10.1001/jama.1982.03320370015016

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In Reply.—  Dr Keshgegian's point is valid and well taken. Although a correlation between the albumin concentration and anion gap would be expected, our study included patients with a narrow range of albumin values. With a wider range of albumin concentrations, say 1.0 to 5.0 g/dL, a positive correlation may be obtained. Also, the analytical error introduced in electrolyte measurements adds to the lack of correlation. We also correlated the total protein concentrations with the anion gap in the individual groups and all patients with hypoalbuminemia without a polyclonal gammopathy. No statistically significant correlation was obtained. Also, the contribution from the anionic proteins other than albumin is minor and would not be expected to contribute substantially to the decrease in the anion gap.Amin A. Nanji, MB, ChB Donald J. Campbell, PhD Morris R. Pudek, PhD Vancouver General Hospital Vancouver, British Columbia