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저알부민혈증에서 관찰한 혈청 전해질, 동맥혈가스 분석과 Anion Gap의 변화
신양수 ( Sin Yang Su ),임현성 ( Im Hyeon Seong ),김원민 ( Kim Won Min ),김완중 ( Kim Wan Jung ),장경식 ( Jang Gyeong Sig ),문철웅 ( Mun Cheol Ung ),김호중 ( Kim Ho Jung ) 대한내과학회 1992 대한내과학회지 Vol.42 No.5
Background : The clinical conditions of hypoal-buminemia known as decreased effective arterial blood volume despite increased total blood volume would be well associated with changes of serum electrolytes and acid-base imbalances at initial presentation and/or on the course of tratments for this hypoalbuminemia. The purpose of this study is to determine the influence of hypoabluminemia related to the diverse underlying causes on concentrations of serum sodium and potassium, arterial blood gas findings and the degree of reduced anion gap as well as cause of it. Methods : Thirty one patients admitted to medical wards with hypoalbuminemia (serum albumin13.1 gm/dL) subdivided to three groups (group 1, nephrotic syndrome; group 2, liver cirrhosis; group 3, other chronic diseases) by underlying diseases, but without hypotension or overt organic acidosis, and seventeen healthy control subjects designated as group 4 (serum albumin>4.0 gm/dL) were included in this prospective study. Simultaneous measurements of serum electrolytes, calculation of anion gap as Na^(+)-(Cl^(-)+HCO^(-)₃), and arterial blood gas analysis were performed. Results : Hyponatremia, hypokalemia and decreased anion gap with more alkalemic pH were observed in mean values of each hypoalbuminemic subgroup when compared to control group with statistical significance (p<0.01) except mean value of serum sodium, serum potassium and alkalemia in a subgroup with nephrotic syndrome. Mean albumin level and mean anion gap of total hypoalbuminemic patients (n=31) were significantly lower compared to those of control healthy subjects (n=17)(p<0.001). However, the difference of reduced anion gap (mean value, 4 mEq/L) was smaller than expected to degree of serum albumin reduction (mean value of reduction, 2.6 gm/dL) on view of more than 2.5 mEq/L of negative charges per 1 gm of serum albumin in normal blood pH. In all 48 subjects, a statistically significant correlation was found between serum sodium and individual albumin (r=0.57, p<0.001), and between the anion gap and individual serum albumin (r=0.62, p<0.001) with no correlation between the anion gap and serum sodium as well as the anion gap and arterial pH. Conclusions: Hyponatremia, hypokalemia, alkalemia and decreased anion gap were commonly noted in patients with hypoalbuminemia in addition to statistical significant positive correlation between the anion gap and individual serum albumin, and between serum sodium and individual serum albumin. The decrement of anion gap associated with hypoalbuminemia was out of proportion to the degree of hypoalbuminemia, which would be explained by summation of other factors associated with hypoalbuminemia, such a s alkalemia, hyponatremia, unidentified anions and increased lactate in alkalemia though not measured in this study.
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