Table of Contents
A) Causes of Increased Anion Gap Metabolic Acidosis
MUD PILERS
- Methanol (antifreeze, windshield fluid, fuel, solvents), Ethanol, etc. Methanol is metabolized to formic acid. And formic acid gives off the H+ that is picked up by bicarb, leaving its conjugate base to raise the AG.
- Uremia (renal failure)
- DKA, alcoholic ketoacidosis
- Paraldehyde –
- Iron, Isoniazid (INH) – cause lactic acidosis.
- Lactic acidosis (Type A, Type B, and D-lactic acidosis). “Lactic acidosis is the most common cause of metabolic in hospitalized patients.”A
- Ethylene glycol (antifreeze),. Ethylene glycol is metabolized to glycolic and oxalic acids.
- Renal Failure(RF), Rhabdomyolysis. RF leads to accumulation of organic anions such as phosphates, sulfates, urates, etc, which increase the AG.
- Salicylates – cause metabolic acidosis and respiratory acidosis.
MA=Metabolic acidosis
MUD PILES
- Methanol,
- Uremia (renal failure)
- Diabetic ketoacidosis,
- Paraldehyde,
- Iron, isoniazid (INH) – cause lactic acidosis.
- Lactic acid,
- Ethanol, ethylene glycol, diethylene glycol, or propylene glycol
- Salicylates
GOLD MARK
- Glycols (propylene glycol and ethylene glycol)
- Oxoproline – 5-oxoproline (or pyroglutamic acid) is associated with chronic acetaminophen use, often by malnourished women.
- L-lactate,
- D-lactate – D-lactic acid can occur in some patients with short bowel syndromes
- Methanol,
- Aspirin,
- Renal failure (vs. uremia)
- Ketoacidosis (DKA, alcoholic ketoacidosis)
Resources and Notes
A). https://www.uptodate.com/contents/causes-of-lactic-acidosis