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Background  The quantitative effect of strong electrolytes, unmeasured strong anions ( UA s), p CO  2 , and plasma protein concentrations in determining plasma p H  can be demonstrated using the physicochemical approach. Plasma anion gap ( AG ) and strong ion gap ( SIG ) are used to assess  UA s in different species.    Hypotheses  Strong ions are a major factor influencing changes in plasma p H  of hospitalized foals.  AG  and  SIG  accurately predict severe hyper‐ l ‐lactatemia ([ l ‐lac − ] > 7 mmol/L).    Animals  Seven hundred and ninety three hospitalized foals < 7 days old.    Methods  Retrospective study. The relationship between measured  pH  and physicochemical variables, and the relationship between plasma [ l ‐lac − ] and  AG  and  SIG , were determined using regression analyses. Optimal  AG  and  SIG  cut points to predict hyper‐ l ‐lactatemia were identified using an  ROC  curve analysis.    Results  Combined, the measured strong ion difference and  SIG  accounted for 54–69% of the changes in the measured arterial  pH  of hospitalized foals.  AG  and  SIG  were significantly associated with plasma [ l ‐lac − ] ( P  < .0001). The receiver operator characteristics ( ROC )  AUC  of  AG  and  SIG  for prediction of severe hyper‐ l ‐lactatemia were 0.89 (95% CI , 0.8–0.95;  P  < .0001) and 0.90 (95% CI , 0.81–0.96;  P  < .0001), respectively. Severe hyper‐ l ‐lactatemia was best predicted by  AG  > 27 mmol/L (sensitivity 80%, 95% CI , 56–94, specificity 85%, 95% CI , 73–93;  P  < .0001) and  SIG  <−15 mmol/L (sensitivity 90%, 95% CI , 68–98; specificity 80%; 95% CI , 68–90;  P  < .0001).    Conclusion and clinical relevance  Altered concentrations of strong ions (Na + , K + , Cl − ) and  UA s were the primary cause of acidemia of hospitalized foals.  AG  and  SIG  were good predictors of hyper‐ l ‐lactatemia and could be used as surrogate tests.

Physicochemical Approach to Determine the Mechanism for Acid–Base Disorders in 793 Hospitalized Foals