High anion gap metabolic acidosis
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|High anion gap metabolic acidosis|
|Classification and external resources|
The list of agents that cause high anion gap metabolic acidosis is similar to but broader than the list of agents that cause a serum osmolal gap.
High Anion Gap Metabolic acidosis is caused generally by the body producing too much acid or not producing enough bicarbonate. This is often an increase in lactic acid or ketoacids, or a sign of kidney failure, and more rarely may be caused by ingesting methanol or overdosing on aspirin. The delta ratio is a formula that can be used to assess elevated anion gap metabolic acidosis and to evaluate whether mixed acid base disorder (metabolic acidosis) is present.
- G — glycols (ethylene glycol & propylene glycol)
- O — oxoproline, a metabolite of acetaminophen
- L — L-lactate, the chemical responsible for lactic acidosis
- D — D-lactate
- M — methanol
- A — aspirin
- R — renal failure
- K — ketoacidosis, ketones generated from starvation, alcohol, and diabetic ketoacidosis
- M — Methanol
- U — Uremia (chronic kidney failure)
- D — Diabetic ketoacidosis
- P — Propylene glycol ("P" used to stand for Paraldehyde but this substance is not commonly used today)
- I — Infection, Iron, Isoniazid, Inborn errors of metabolism
- L — Lactic acidosis
- E — Ethylene glycol (Note: Ethanol is sometimes included in this mnemonic as well, although the acidosis caused by ethanol is actually primarily due to the increased production of lactic acid found in such intoxication.)
- S — Salicylates
Another frequently used mnemonic is KARMEL.
Another frequently used mnemonic is KUPIN.
- K — Ketoacidosis (DKA, AKA)
- U — Uremia
- P — Production (Lactic acidosis)
- I — Ingestion (Ethylene glycol, methanol)
- N — Need to Remember Drugs (aspirin, Metformin)
The mnemonic for the [rare, in comparison] toxins is ACE GIFTs: Aspirin, Cyanide, Ethanolic ketosis, Glycols [ ethylene and propylene ], Isoniazid, Ferrous iron, Toluene. Most of these cause a lactic acidosis.
- "Anion Gap (Blood)". University of Rochester Medical Center. Retrieved 2014-02-18.
- Sabatini, S; Kurtzman, NA (2009). "Bicarbonate Therapy in Severe Metabolic Acidosis". Journal of the American Society of Nephrology 20 (4): 692–695. doi:10.1681/asn.2007121329.
- Mehta, Ankit. "GOLD MARK: an anion gap mnemonic for the 21st century". Lancet 372 (9642): 892. doi:10.1016/S0140-6736(08)61398-7. PMID 18790311.
- MedicalMnemonics.com: 1203 3255
- Anion Gap: Acid Base Tutorial, University of Connecticut Health Center
- Reid, Hugh. "Dr". unpublished. Retrieved 28 November 2013.
- Chang CT, Chen YC, Fang JT, Huang CC (September 2002). "High anion gap metabolic acidosis in suicide: don't forget metformin intoxication--two patients' experiences". Ren Fail 24 (5): 671–5. doi:10.1081/JDI-120013973. PMID 12380915.
- "Metabolic Acidosis: Acid-Base Regulation and Disorders: Merck Manual Professional". Retrieved 2008-12-04.
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