Case 8-2001: Low Anion Gap in Lymphoplasmacytic Lymphoma

To the Editor: In his excellent discussion of Case 8-2001 (March 15 issue), 1 Dr. Wong did not mention that the low anion gap is another helpful clinical clue. On the day of admission, the patient had a relatively low anion gap of 5 mmol per liter, and the value on the third hospital day was 4 mmol per liter. Given such findings, the differential diagnosis is limited to three underlying mechanisms: a decrease in the levels of unmeasured anions (i.e., albumin); inaccuracies in the laboratory determinations of sodium or chloride that are related to the presence of hypertriglyceridemia, very high . . .