The Serum Anion Gap (AG)...Why is NAGMA associated with High Serum Chloride?

Why is NAGMA associated with High Serum Chloride?
Why is normal anion gap metabolic acidosis (NAGMA) hyperchloremic? Have you ever wondered why?
#medicosis_ever_wonder-why?
There are 4 main conditions of Acid-Base Imbalance: Metabolic acidosis, Metabolic Alkalosis, Respiratory Acidosis, Respiratory Alkalosis..
Metabolic acidosis is subdivided into HAGMA and NAGMA.
We differentiate between HAGMA and NAGMA based on the serum anion gap (AG).
We differentiate between renal NAGMA vs non-renal NAGMA based on the urine anion gap (UAG).

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[rumeysaeed]

I love the new series ever wonder why! As I ask “why” all the time. Gonna love that. And I am not a big fan of blindly memorising I am even scared of it. So I now know why ı like your channel &thank you!

[afiohotu]

HAGMA is normochloremic because in this case no negative ion is being lost so no negative ion(i.e chloride) is gained. So chloride levels remain stagnant while bicarbonate levels drop

Bicarbonate levels drop not because it is being lost but because it is being converted to carbonic acid by accepting a proton from the excess of organic acids in I think😅

[jangtank]

Top notch stuff. Incredibly well explained. Liked + Subscribed + Notified.

EDIT: Why is HAGMA normochloremic?

HAGMA = Increased organic acids --> Dissociates into conjugate base & H+ --> Bicarb consumed to buffer H+
Net effect: Increased AG + Preservation of electroneutrality. Transcellular shifting of Cl not required

[talabatbouta]

Hey medicosis i passed my hematology exam thanks to you and i just wanted to say thanks :)

[mipthef]

I m so happy to hear that you enjoy Sowell
It is proof that you have a healthy non extremist mind
I love this channel even more now
We need more stuff like NAGMA 2021!

[.santhoshkumar.m]

Super and marvelous and completely understandable video even if we start from 0

[egeuzunsakal]

Im amazed by how good you're teaching this stuff. <3

[xaaboopinkly]

Thanks sir! Never going to miss any of your valuable videos and lectures!

[clashju]

Hey medicosis you explained so well
Just wanna say thank you

[milymaj]

Great, great, great video. Thank you. All makes sense now.

[Lavanya-gfbq]

I understood that why NAGMA is hyperchloremic ....very well.... but am confused why your introduction says why NAGMA is normochloremic

[nikolamarkovic]

Tnx fpr reccomendetion of the books. Give us more that.

[samstuart-gunh]

any guy cool with thomas sowell is cool with me

[flightdoc]

Good content.. but to me at least, the "Why?" intro was a bit too much.. like we got the point bro.. there's a lot of whys in medicine lol, 3 examples were already good enough.. no offense intended.

[omarkatranji]

Legend Senna once said "If you no longer go for a gap that exists, you are no longer a racing driver", and since you say the gap does NOT exist... I'm sorry to say this but you ain't no racer anymore..

[thesmartpotato]

"there us no easter bunny, there's no tooth fairy, and there's no anion gap!"

Great video, thanks a ton <3

[peterdreff]

Dude, mmol/l … this should be used
Get to your point quickly

[RR-jsyx]

I'm sorry, but why is there no compensation of chloride electrolyte in HAGMA? Is it because there is no loss of bicarbonate?

[annawright]

Trying an answer to the Q: in NAGMA acidosis is due to loss of carbonate (by the doofuses) to which the Cl (-) gain is the correcting response, the quick-fix of the electroneutrality law. In HAGMA the acidosis is due to increased H (+) therefore the balancing response will be perhaps Na(+) gain in plasma (?). I might be wrong - just trying to take the challenge😊.

[modernmedicine]

too much blabbering..here's a summary..

the AG is the space filled by anything else besides HCO3 and Cl.

remember acidic compound will dissociate to from Hydrogen ions and Anions. The H+ from weak acids are buffered by the existing HCO3- while the A- anion constitute the Anion gap @ unmeasured anions.


if you have a bigger gap, it basically means there's an "additional" anion which can be either endo/exogenous origin. --> hence why ingestion and organic acidoses are HAGMA.

if the gap is normal, essentially nothing "additional" is gained, just simple loss (HCO3 loss and Cl reuptake) --> hence why the GAP is unaffected.

AG doesnt tell you the severity of acidoses, but it give some clue to the potential causes.