Anion gap metabolic acidosis: Difference between revisions
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=== GOLDMARK === |
=== GOLDMARK === |
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* Glycols: ethylene (AKI, osmolar gap) and propylene (osmolar gap) |
* Glycols: [[Ethylene glycol toxicity|ethylene]] ([[AKI]], osmolar gap) and [[Propylene glycol toxicity|propylene]] (osmolar gap) |
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* Oxoproline (acetaminophen) |
* Oxoproline ([[Acetaminophen overdose|acetaminophen]]) |
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* L-lactic acidosis: rapid-onset |
* L-lactic acidosis: rapid-onset |
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* D-lactic acidosis: bowel stasis |
* D-lactic acidosis: bowel stasis |
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* Methanol: visual changes, osmolar gap |
* [[Methanol toxocity|Methanol]]: visual changes, osmolar gap |
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* ASA |
* [[ASA]] |
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* Renal failure |
* Renal failure |
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* Ketoacidosis |
* [[Ketoacidosis]] |
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=== Biochemical Approach === |
=== Biochemical Approach === |
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*** Systemic hypoperfusion and shock |
*** Systemic hypoperfusion and shock |
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** Type B |
** Type B |
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*** Metformin |
*** [[Metformin]] |
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*** Malignancy |
*** Malignancy |
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*** Chronic alcohol intake (mild) |
*** Chronic alcohol intake (mild) |
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*** HIV medications |
*** [[HIV]] medications |
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*** IV epinephrine |
*** IV epinephrine |
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*** Mitochondrial dysfunction |
*** Mitochondrial dysfunction |
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*** Propofol |
*** [[Propofol]] |
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*** Linezolid |
*** [[Linezolid]] |
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** D- |
** [[D-lactic acidosis]]: short bowel syndrome |
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* Ketoacidosis |
* Ketoacidosis |
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** Diabetic ketoacidosis (DKA) |
** [[Diabetic ketoacidosis]] (DKA) |
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** Alcoholic ketoacidosis |
** [[Alcoholic ketoacidosis]] |
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** Starvation |
** [[Starvation ketoacidosis|Starvation]] |
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* Toxins |
* Toxins |
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** Salicylates |
** Salicylates |
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* Renal failure (acute or chronic) |
* Renal failure (acute or chronic) |
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== |
== Clinical Manifestations == |
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== Risk Factors == |
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== Clinical Presentation == |
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* Rapid onset: lactic acidosis |
* Rapid onset: lactic acidosis |
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* Serum electrolytes |
* Serum electrolytes |
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** Anion gap |
** Anion gap |
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** Delta-delta: increase in anion gap should be matched by equal decrease in |
** Delta-delta: increase in anion gap should be matched by equal decrease in bicarb |
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* Serum osmolarity |
* Serum osmolarity |
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* Lactate, to rule out lactic acidosis |
* Lactate, to rule out lactic acidosis |
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Latest revision as of 21:25, 27 April 2024
Definition
- Metabolic acidosis with an increased anion gap
Differential Diagnosis
GOLDMARK
- Glycols: ethylene (AKI, osmolar gap) and propylene (osmolar gap)
- Oxoproline (acetaminophen)
- L-lactic acidosis: rapid-onset
- D-lactic acidosis: bowel stasis
- Methanol: visual changes, osmolar gap
- ASA
- Renal failure
- Ketoacidosis
Biochemical Approach
- Lactic acidosis
- Type A: impaired tissue oxygenation
- Systemic hypoperfusion and shock
- Type B
- D-lactic acidosis: short bowel syndrome
- Type A: impaired tissue oxygenation
- Ketoacidosis
- Toxins
- Salicylates
- Acetaminophen (5-oxoproline)
- Methanol (formic acid)
- Ethylene glycol (glycolic acid and oxalic acid)
- Renal failure (acute or chronic)
Clinical Manifestations
- Rapid onset: lactic acidosis
- Osmolar gap: methanol, ethanol, ethylene glycol
- Visual changes: methanol
- AKI: ethylene glycol
- Normal pH: ethanol
- Slow bowel transit: D-lactic acidosis
Investigations
- Serum electrolytes
- Anion gap
- Delta-delta: increase in anion gap should be matched by equal decrease in bicarb
- Serum osmolarity
- Lactate, to rule out lactic acidosis
Management
- Treat underlying cause
