Metabolic acidosis, increased anion gap
Definition
- Gap >12 meq
Etiology
- Lactic acidosis
- Type A (tissue hypoxia): cardiogenic, septic, or hemorrhagic shock; seizure; carbon monoxide or cyanide poisoning
- Type B (nonhypoxic): hepatic or renal failure, intestinal ischemia, diabetes especially with metformin use, ketoacidosis, infection, leukemia or lymphoma, drugs (ethanol, methanol, salicylates, isoniazid), AIDS, idiopathic (usually in debilitated patients)
- Diabetic ketoacidosis
- Starvation ketoacidosis
- Alcoholic ketoacidosis
- Frequently with mixed disorders (10% have triple acid-base disorder)
- Acid-base disorders in alcoholism include: three types of metabolic acidosis (ketoacidosis, lactic acidosis, or hyperchloremic acidosis from bicarbonate loss in urine from ketonuria); metabolic alkalosis from volume contraction and vomiting; respiratory alkalosis from alcohol withdrawal, pain, sepsis, or liver disease
- Uremic acidosis (usually at GFR <20 mL/min)
- Ethylene glycol toxicity
- Methanol toxicity
- Salicylate toxicity (mixed metabolic acidosis with respiratory alkalosis)
- Other: paraldehyde, isoniazid, iron, rhabdomyolysis
See related DDx
Last updated: December 1, 2014
Citation
Zeiger, Roni F.. "Metabolic Acidosis, Increased Anion Gap." Diagnosaurus, 4th ed., McGraw-Hill Education, 2014. Emergency Central, emergency.unboundmedicine.com/emergency/view/Diagnosaurus/114286/all/Metabolic_acidosis__increased_anion_gap.
Zeiger RFR. Metabolic acidosis, increased anion gap. Diagnosaurus. McGraw-Hill Education; 2014. https://emergency.unboundmedicine.com/emergency/view/Diagnosaurus/114286/all/Metabolic_acidosis__increased_anion_gap. Accessed December 1, 2024.
Zeiger, R. F. (2014). Metabolic acidosis, increased anion gap. In Diagnosaurus (4th ed.). McGraw-Hill Education. https://emergency.unboundmedicine.com/emergency/view/Diagnosaurus/114286/all/Metabolic_acidosis__increased_anion_gap
Zeiger RFR. Metabolic Acidosis, Increased Anion Gap [Internet]. In: Diagnosaurus. McGraw-Hill Education; 2014. [cited 2024 December 01]. Available from: https://emergency.unboundmedicine.com/emergency/view/Diagnosaurus/114286/all/Metabolic_acidosis__increased_anion_gap.
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