Advanced Patient Assessment Practice Exam

What does a high anion gap indicate in metabolic acidosis?

1. Loss of bicarbonate

2. Increased acid production

3. Excessive alkali intake

4. Retention of bicarbonate

The correct answer is: Increased acid production

A high anion gap in metabolic acidosis indicates the presence of excess acids in the bloodstream, which can arise due to increased acid production. This condition reflects an accumulation of unmeasured anions in the plasma, such as lactate or ketones, which can result from various pathological processes. For instance, in cases such as diabetic ketoacidosis or lactic acidosis, the body generates excessive amounts of acids, causing a rise in the anion gap. Elevated levels of these unmeasured anions consume bicarbonate, contributing to the metabolic acidosis. Therefore, a high anion gap serves as a valuable diagnostic marker, guiding clinicians towards the underlying cause of the metabolic derangement. The other options do not correlate with the implications of a high anion gap in the same way. Loss of bicarbonate typically results in a normal anion gap metabolic acidosis, while excessive alkali intake would usually lead to alkalosis rather than acidosis. Retention of bicarbonate implies a compensatory response and does not align with the presence of a high anion gap. Consequently, recognizing that increased acid production leads to a high anion gap is essential for understanding the metabolic processes at play.