High anion gap metabolic acidosis
 | This article provides insufficient context for those unfamiliar with the subject. (February 2014) |
| High anion gap metabolic acidosis | |
|---|---|
| Specialty | Nephrology  |
High anion gap metabolic acidosis is a form of metabolic acidosis characterized by a high anion gap
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 renal failure, and more rarely may be caused by ingesting methanol or overdosing on aspirin.[1][2] 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.
Causes
Causes include:
"Mudpiles"
The mnemonic MUDPILES is commonly used to remember the causes of increased anion gap metabolic acidosis.[3][4]
- M-Methanol
- U-Uremia (chronic renal 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.
- K-Ketoacidosis
- A-ASA
- R-Renal failure
- M-Methanol
- E-Ethylene glycol
- L-Lactic acidosis
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 (ASA, Metformin)
Perhaps the easiest mnemonic is KULT: ketones, uremia, lactate [because these are the most common causes of a HAGMA] and toxins [ so we don't forget ]. 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.[5]
Other
References
- ^ "Anion Gap (Blood)". University of Rochester Medical Center. Retrieved 2014-02-18.
{{cite web}}: Cite has empty unknown parameter:|coauthors=(help) - ^ 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.
- ^ 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.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - ^ "Metabolic Acidosis: Acid-Base Regulation and Disorders: Merck Manual Professional". Retrieved 2008-12-04.
 | This medical article is a stub. You can help Wikipedia by expanding it. |