Anion gap metabolic acidosis: Difference between revisions
From IDWiki
m (Text replacement - "Clinical Presentation" to "Clinical Manifestations") |
No edit summary |
||
| Line 7: | Line 7: | ||
=== GOLDMARK === |
=== GOLDMARK === |
||
* Glycols: ethylene (AKI, osmolar gap) and propylene (osmolar gap) |
* Glycols: [[Ethylene glycol toxicity|ethylene]] ([[AKI]], osmolar gap) and [[Propylene glycol toxicity|propylene]] (osmolar gap) |
||
* Oxoproline (acetaminophen) |
* Oxoproline ([[Acetaminophen overdose|acetaminophen]]) |
||
* L-lactic acidosis: rapid-onset |
* L-lactic acidosis: rapid-onset |
||
* D-lactic acidosis: bowel stasis |
* D-lactic acidosis: bowel stasis |
||
* Methanol: visual changes, osmolar gap |
* [[Methanol toxocity|Methanol]]: visual changes, osmolar gap |
||
* ASA |
* [[ASA]] |
||
* Renal failure |
* Renal failure |
||
* Ketoacidosis |
* [[Ketoacidosis]] |
||
=== Biochemical Approach === |
=== Biochemical Approach === |
||
| Line 22: | Line 22: | ||
*** Systemic hypoperfusion and shock |
*** Systemic hypoperfusion and shock |
||
** Type B |
** Type B |
||
*** Metformin |
*** [[Metformin]] |
||
*** Malignancy |
*** Malignancy |
||
*** Chronic alcohol intake (mild) |
*** Chronic alcohol intake (mild) |
||
*** HIV medications |
*** [[HIV]] medications |
||
*** IV epinephrine |
*** IV epinephrine |
||
*** Mitochondrial dysfunction |
*** Mitochondrial dysfunction |
||
*** Propofol |
*** [[Propofol]] |
||
*** Linezolid |
*** [[Linezolid]] |
||
** D- |
** [[D-lactic acidosis]]: short bowel syndrome |
||
* Ketoacidosis |
* Ketoacidosis |
||
** Diabetic ketoacidosis (DKA) |
** [[Diabetic ketoacidosis]] (DKA) |
||
** Alcoholic ketoacidosis |
** [[Alcoholic ketoacidosis]] |
||
** Starvation |
** [[Starvation ketoacidosis|Starvation]] |
||
* Toxins |
* Toxins |
||
** Salicylates |
** Salicylates |
||
| Line 41: | Line 41: | ||
** Ethylene glycol (glycolic acid and oxalic acid) |
** Ethylene glycol (glycolic acid and oxalic acid) |
||
* Renal failure (acute or chronic) |
* Renal failure (acute or chronic) |
||
== Epidemiology == |
|||
== Risk Factors == |
|||
== Clinical Manifestations == |
== Clinical Manifestations == |
||
| Line 59: | Line 55: | ||
* Serum electrolytes |
* Serum electrolytes |
||
** Anion gap |
** Anion gap |
||
** 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 |
||
* Serum osmolarity |
* Serum osmolarity |
||
* Lactate, to rule out lactic acidosis |
* Lactate, to rule out lactic acidosis |
||
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
