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(Chest. 1996;109:504-509.)
© 1996 American College of Chest Physicians

Anion Gap in Turpentine-Induced Pleural Effusions

Correlation With pH and Protein Level

William D. Paulson MD1; Michelene Hearth-Holmes MD2; Steven W. Stogner MD3; G. Douglas Campbell Jr. MD, FCCP3; Katharine A. Kirk PhD4; and Ronald B. George MD, FCCP3

1 From the Section of Nephrology and Hypertension, in the Department of Medicine Louisiana State University Medical Center Shreveport
2 From the Center of Excellence for Arthritis and Rheumatology, in the Department of Medicine Louisiana State University Medical Center Shreveport
3 From the Section of Pulmonary and Critical Care, in the Department of Medicine Louisiana State University Medical Center Shreveport
4 From the Department of Biostatistics, School of Public Health, University of Alabama at Birmingham

Since the pleural fluid proteins and lactate are unmeasured anions, the pleural fluid anion gap (Na+K-Cl-total CO2) should vary with the protein level and should be high in acidic effusions (which have high lactate levels). The anion gap is also convenient and inexpensive to measure, and less subject to artifact than the pH measurement. To test the hypothesis that the anion gap correlates with the pH, protein level, and other traditional pleural fluid measurements, we used a well-described model of turpentine-induced effusions in nine New Zealand white rabbits. Nonacidic exudative effusions were induced by an intrapleural injection of turpentine; acidic exudative effusions were induced by a second injection. Pleural fluid and blood were obtained just before (0 h) and 9, 24, 48, and 72 h after the second injection. We found the anion gap correlated with pH, the glucose, protein, and lactate dehydrogenase levels, pleural-fluid/plasma protein and lactate dehydrogenase ratios, and WBC count (all p<0.001). The pH and protein ratio together accounted for 95% of all anion gap variation within individual subjects. We also found the influence of the PCO2 level on pH was not significant after taking into account the influence of the anion gap. These results suggest the anion gap may be useful in the clinical evaluation of pleural effusions and could potentially replace the pH measurement.

Key Words: acid-base imbalance • anion gap • exudate • lactic acidosis • pleural effusion

Submitted on March 17, 1995
Accepted on August 9, 2007






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