What explains the lack of an increased anion gap seen in metabolic acidosis caused by HCO3– loss?
a. For each HCO3– ion lost, a Cl– ion is reab-sorbed by the kidney.
b. For each HCO3– ion lost, the body pro-duces another to replace it.
c. HCO3– is not a measured anion, so its loss does not affect the anion gap.
d. Replacement of HCO3– occurs by ammo-nia ions which are also anions.
ANS: A
A metabolic acidosis caused by HCO3– loss from the body does not cause an increased anion gap. Bicarbonate loss is accompanied by Cl– ion gain, which keeps the anion gap within normal limits (Figure 14-7, C).
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