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Acid-Base, Electrolyte And Renal Emergencies
Published in Anthony FT Brown, Michael D Cadogan, Emergency Medicine, 2020
Anthony FT Brown, Michael D Cadogan
Causes of a high anion gap metabolic acidosis (anion gap >16) include: Increased acid production: ketoacidosis, e.g. diabetes, alcoholism, starvationlactic acidosis (serum lactate >2.5 mmol/L): type A: impaired tissue perfusion in cardiac arrest, shock, hypoxia, sepsis, mesenteric ischaemiatype B: impaired carbohydrate metabolism in hepatic or renal failure, lymphoma, pancreatitis and drugs such as metformin and salbutamol.Decreased acid excretion, as in renal failure.Exogenous acid ingestion: methanol, ethylene glycol, iron, cyanide and salicylates.
Acid–base disturbances
Published in Sherif Gonem, Ian Pavord, Diagnosis in Acute Medicine, 2017
The normal range for the osmolal gap is 10–15 mOsm/kg. A value higher than this implies the presence of a significant quantity of unmeasured osmotically active solutes. Therefore the osmolal gap is a useful diagnostic tool for the investigation of unexplained high anion gap metabolic acidosis. The commonest cause of an elevated osmolal gap in clinical practice is poisoning by volatile alcohols.
Acid–base disturbances
Published in Martin Andrew Crook, Clinical Biochemistry & Metabolic Medicine, 2013
Lactic acidosis is a common form of high anion gap metabolic acidosis; some of the causes are shown in Box 4.2. One definition used is an arterial pH of less than 7.2 with a plasma lactate concentration greater than 5.0 mmol/L. The normal fasting blood lactate is between 0.4 and 1.0 mmol/L, which can rise to 1.5 mmol/L on prolonged exercise (hyperlactataemia).
Intoxication with Fireball Whiskey causing severe lactic acidosis
Published in Baylor University Medical Center Proceedings, 2021
Moeed Ahmed, Sunil K. Jagadesh, Mohamad Ali Alhajhusain, Sangeeta Mutnuri
Both patients had severe lactic acidosis and acute kidney injury in the setting of Fireball Whiskey consumption. The second patient also had high anion gap metabolic acidosis and a high osmolal gap. Propylene glycol is considered a relatively safe alcohol compared with methanol and ethylene glycol. There have been several reports of severe lactic acidosis occurring in the setting of iatrogenic unintentional overdosing of medications that use propylene glycol as a diluent, including lorazepam and diazepam.3–5 However, there have not been many case reports of severe lactic acidosis in the setting of liquor containing propylene glycol. One case described high anion gap metabolic acidosis with high osmolal gap in the setting of liquor containing propylene glycol.6
Life-threatening triclopyr poisoning due to diethylene glycol monoethyl ether solvent
Published in Clinical Toxicology, 2021
K.Z. Isoardi, C.B. Page, M.S. Roberts, G.K. Isbister
The cause of the high anion gap metabolic acidosis in these cases is likely due to the glycol ether DEGEE, which can cause a high anion gap, high osmolar gap metabolic acidosis. [5] Similar to other agrochemicals such as glyphosate [6] and dimethoate [7] toxicity may be largely related to the solvent rather than the active compound. Triclopyr itself is an organic acid with a pKa of 2.68 [3] and may be responsible. However, triclopyr clearance appeared to be unaffected by dialysis suggesting the exogenous acid accounting for the high anion gap is not related to triclopyr concentrations.
Approach to the patient presenting with metabolic acidosis
Published in Acta Clinica Belgica, 2019
Jill Vanmassenhove, Norbert Lameire
For reasons of space, the present paper will only focus on the most frequent types of high anion gap metabolic acidosis, including ketoacidosis due to alcohol abuse or starvation, L- (and D-) lactic acidosis, and metabolic acidosis due to ingestion of toxins. Diabetic ketoacidosis is covered elsewhere in this issue. Uremic acidosis, pyroglutamic acidosis, metabolic acidosis due to exogenous acids or medication and due to inborn errors of metabolism will not be covered. The reader is referred to more in-depth reviews [3–9].