An increased anion gap may be due to:

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The anion gap is increased when negatively charged anions,other than chloride and bicarbonate,are increased in the plasma.These anions include ketones,present in diabetic ketoacidosis; lactic acid,an increase indicating inadequate tissue oxygenation; and alcohols,including ethanol and methanol.An increased anion gap is therefore suggestive of metabolic disorders or alcohol intoxication.Calcium and magnesium are cations.Elevated levels of calcium and magnesium-hypercalcemia and hypermagnesemia,respectively-will decrease the anion gap.The anion gap will also be decreased in hypoproteinemia because less protein is available to bind plasma cations.

An Increased Anion Gap May Be Due To