The mean and central 90% range of decreased anion gap were 3 and 2-4 mmol/l, which were lower than those reported in previous study (6 and 3-8 mmol/l). The mean and central 90% range of increased anion gap were 16 and 13-20 mmol/l, which was lower than those reported in previous study (25 and 19-28 mmol/l). From the retrospective study on the 6868 sets of serum electrolyte among hospitalized patients, we found the incidences of normal, increased, and decreased anion gaps were 59.5%, 37.6%, and 2.9%, respectively. The reference range of anion gap obtained from 124 healthy volunteers was 5-12 mmol/l, which was low and confirmed the reports from other studies (3-11 mmol/l) using ion-selective electrode. We estimated the reference range using the non-parametric percentile estimation method. The anion gap was calculated from the formula. We analyzed serum electrolyte using the Beckman Synchron CX5. Criteria for using anion gap were also suggested. Our study updated the value of anion gap in clinical diagnosis and laboratory evaluation. This may lead to misinterpretation of the value of anion gap. However, clinicians and textbooks still refer and use the old reference value of 8-16 mmol/l. At present, the reference range of anion gap has been lowered from 8-16 to 3-11 mmol/l because of the changes in technique for measuring electrolyte. It approximates the difference between the concentration of unmeasured anions (UA) and unmeasured cations (UC) in serum. Anion gap (AG) is a calculated value commonly used in clinical practice.
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