Serum Anion Gap
Evaluates metabolic acidosis etiology
- Highest activation tier
- Recommended
- How it is scored
- Scored in code; a stated value is compared only from the structured summary or a supplied value
- Care settings
- Emergency department, ICU, Inpatient
When it activates
Scribeable activates a calculator from the encounter. The Serum Anion Gap can activate when the transcript or pasted chart context documents any of these:
- Metabolic acidosis evaluation
- DKA/HHS workup
- Toxic ingestion workup
- Unexplained acidosis
A coded diagnosis can also activate it. ICD-10 prefixes carried by the registry: E87.
Inputs the note needs
4 inputs. Each is resolved from the transcript, the pasted chart context and charted labs; at this calculator’s tier a missing input is never requested, and a missing required input keeps the score out of the draft.
| Input | Type | Unit / options | Guidance |
|---|---|---|---|
| Serum sodium | lab | mEq/L | |
| Serum chloride | lab | mEq/L | |
| Serum bicarbonate | lab | mEq/L | |
| Serum albumin (optional, enables albumin-corrected AG) | lab | g/dL |
Scoring
AG = Na - (Cl + HCO3). Normal: 10-12 mEq/L.
AG = Serum sodium − (Serum chloride + Serum bicarbonate)
Interpretation
Normal: 10-12. Elevated gap causes (MUDPILERS): Methanol, Uremia, DKA, Paraldehyde, INH/Iron, Lactic acidosis, Ethylene glycol, Rhabdo, Salicylates.
Evidence
Sources carried in Scribeable's citation registry for this calculator.
- CMS Merit-based Incentive Payment System (MIPS) Quality Measures 2026CMS MIPS 2026 · 2026 · CMS · link last verified 2026-03-23
How Scribeable handles it in the note
When an encounter activates the Serum Anion Gap (its highest tier is recommended), Scribeable does not ask you for missing inputs. The score is computed in code from whatever inputs resolve from the transcript, the pasted chart context or charted labs; a computed value is written into the draft only when every required input already resolves.
The score is computed in code from the resolved inputs, not recalled by the language model. A stated Serum Anion Gap value is compared against the computed one when the draft's structured summary carries it; a disagreement found there is flagged to the second drafting pass, which is instructed to correct the score and its interpretation, unless Scribeable has supplied the computed value to that pass, in which case the value the draft writes is checked against the supplied one and a detected difference is shown beside the note for you to adjudicate rather than silently rewritten.
Classified as a deterministic formula: a spare suggestion is easy to ignore, so activation is permissive.
See it activate on your own encounter
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