DIP Ep 625: The 5 USMLE “Gaps” (Step 1-3)

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Divine-Favour Anene

Medicine, Education, Science & Medicine, Higher Education

4.9 • 929 Ratings

🗓️ 11 November 2025

⏱️ 42 minutes

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Summary

In this podcast, I conceptually explain the 5 different gaps tested on the USMLEs (Serum AG, Urine AG, Osmolal gap, SAAG gradient, and A-a gradient). I make numerous integrations and really help you understand these things so you don’t have to memorize them. Another point of emphasis (low SAAG ascites is similar conceptually to exudative … Continue reading DIP Ep 625: The 5 USMLE “Gaps” (Step 1-3)

Transcript

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0:00.0	Welcome. My name is Divine. This is episode 625 of the Divine Intervention Podcast. In today's podcast, we're going to be addressing gaps. We're going to be addressing what gaps. I'm going to call this podcast literally gaps and the USMLEs. Gaps and the USML is they love to test gaps. And the thing is I've
0:25.3	noticed in my experience, many students struggle with these gaps. So my goal is to really help you
0:31.5	understand them so you can cross your exams. All right. So the very first one I'm going to start
0:36.4	off with is the anion gap. It's the
0:40.3	anion gap. So the thing is we know that there are two anion gaps that are commonly tested on the
0:47.3	USMLA exams, right? There is high ion ion gaps and there's normal anion gap. So the first thing we
0:53.0	should try to figure out is what's the
0:54.7	anion gap formula. We know that many times we use this in reference to metabolic acidosis.
1:00.6	And anion gap is pretty much your sodium minus your chloride plus bicarb, right? So your sodium
1:07.5	minus your chloride plus bicarb. So let's look at this.
1:12.4	Sodium is a cation.
1:14.2	It's positively charged.
1:16.0	Chloride is an anion.
1:17.8	It's negatively charged.
1:19.7	Bicarb is an anion.
1:21.6	It's negatively charged.
1:23.2	But I want to say something to you.
1:25.8	There are other anions in the body that are not considered in this formula.
1:30.8	There are other cations in the body that are not considered in this formula.
1:35.3	So let's conceptually try to understand.
1:39.7	And I guess before I jump in there, right?
1:42.3	So what's a normal an ion gap? A normal an ion gap is
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