Pediatric emergency medicine trisk 2879 2879
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osmolal gap, defined as the difference between the measured and calculated
serum osmolality. Normal osmolal gap is considered less than 10.
Calculated serum osmolality is determined by the following formula:
Calculated Sosm = (2 × serum[Na]) + (glucose [mg/dL])/18 + (blood urea
nitrogen [mg/dL])/2.8
In addition to serum electrolytes and serum albumin, initial laboratory
studies should include serum glucose, BUN, creatinine, serum osmolality,
and urinalysis with urine pH. A higher than expected urine pH in the setting
of acidosis may suggest renal tubular acidosis (RTA). Further studies are
based upon clinical suspicion.
TABLE 100.11
CAUSES OF METABOLIC ACIDOSIS WITH RESPECT TO THE
ANION GAP
Elevated anion gap
Lactic acidosis
Hypoperfusion
Inborn errors of carbohydrate metabolism
Mitochondrial disorders
Diabetic ketoacidosis
Inborn errors of metabolism
Organic acidemias
Fatty acid oxidation defects
Ingestions
Methanol, ethanol, ethylene glycol, salicylates
Renal failure
Normal anion gap
Renal tubular acidosis
Diarrhea
Enteric fistulae
Ureterosigmoidostomy
Early renal failure
