Which condition is associated with low anion gaps?

A low anion gap can arise from various clinical conditions, most notably due to low levels of negatively charged proteins in the blood, increased amounts of positively charged substances, or the presence of unmeasured anions. In the context of multiple myeloma, the disease results in elevated levels of abnormal proteins (monoclonal immunoglobulins) in the bloodstream. This change can significantly affect the concentrations of measurable anions and cations, often leading to a lower calculated anion gap.

Hypoalbuminemia can contribute to reduced levels of serum albumin, which is a significant negatively charged protein. When albumin levels are low, the overall negative charge decreases, leading to a low anion gap value. Moreover, high levels of calcium, as seen in hypercalcemia, can also influence the balance of charged particles, but the overarching effect in multiple myeloma is the profound increase in abnormal protein levels.

In this scenario, the combination of hypoalbuminemia, hypercalcemia, and the presence of monoclonal proteins in multiple myeloma presents a clear context for low anion gap readings. Thus, this option correctly identifies the condition associated with low anion gaps while considering the underlying biochemical changes that affect acid-base