High anion gap metabolic acidosis
| High anion gap metabolic acidosis | |
|---|---|
 | |
| Classification and external resources | |
| Specialty | endocrinology |
| ICD-10 | E87.2 |
| ICD-9-CM | 276.2 |
| DiseasesDB | 15112 |
High anion gap metabolic acidosis is a form of metabolic acidosis characterized by a high anion gap (a medical value based on the concentrations of ions in a patient's serum). An anion gap is usually considered to be high if it is over 11 mEq/L.
High anion gap metabolic acidosis is caused generally by the body producing too much acid or not producing enough bicarbonate. This is often due to an increase in lactic acid or ketoacids, or it may be a sign of kidney failure. More rarely, high anion gap metabolic acidosis 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.
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.
Causes
Causes include:
The newest mnemonic was proposed in The Lancet reflecting current causes of anion gap metabolic acidosis:[3]
- G — glycols (ethylene glycol & propylene glycol)
- O — oxoproline, a metabolite of paracetamol
- 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
The mnemonic MUDPILES is commonly used to remember the causes of increased anion gap metabolic acidosis.[4][5]
- 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.
- K — Ketoacidosis
- A — aspirin
- 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 (aspirin, Metformin)
The preferred mnemonic of D. Robert Dufour, the chief of the Pathology and Laboratory Medicine Service, Veterans Affairs Medical Center, is DUMPSALE, which omits the I of MUDPILES as the proposed values of *I* are exceedingly rare in clinical practice.
- D — Diabetic ketoacidosis
- U — Uremia
- M — Methanol
- P — Paraldehyde
- S — Salicylates
- A — Alcoholic ketoacidosis
- L — Lactic acidosis
- E — Ethylene Glycol
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.[6]
Other
See also
References
- ↑ "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.