Skip to main content

High Anion Gap Metabolic Acidosis

  • Chapter
  • First Online:
Book cover Fluid, Electrolyte and Acid-Base Disorders

Abstract

In the previous chapter, we presented various causes of high anion gap (AG) metabolic acidosis. For discussion purpose, these causes can be conveniently divided into the following categories:

  1. 1.

    Acidosis due to kidney injury

    Acute kidney injury

    Chronic kidney disease (CKD) stages 4–5

  2. 2.

    Acidosis due to accumulation of organic acids

    l-Lactic acidosis

    d-Lactic acidosis

    Diabetic ketoacidosis

    Alcoholic ketoacidosis

    Starvation ketoacidosis

  3. 3.

    Acidosis due to toxins

    Methanol

    Ethylene glycol

    Propylene glycol

    Isopropyl alcohol

    Salicylates

    5-Oxoproline (pyroglutamic acid)

    Paraldehyde

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 64.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Reference

  1. Barceloux DG, Krenzelok EP, Olson K, et al. American academy of clinical toxicology practice guidelines on the treatment of ethylene glycol poisoning. J Toxicol Clin Toxicol. 1999;37:537–60.

    Article  CAS  PubMed  Google Scholar 

Suggested Reading

  1. Cerdá J, Tolwani AJ, Warnock DG. Critical care nephrology: management of acid-base disorders with CRRT. Kidney Int. 2012;82:9–18.

    Article  PubMed  Google Scholar 

  2. Fall PJ, Szerlip HM. Lactic acidosis: from sour milk to septic shock. J Intensive Care Med. 2005;20:255–71.

    Article  PubMed  Google Scholar 

  3. Fenves AZ, Kirkpatrick HM III, Patel VV, et al. Increased anion gap metabolic acidosis as a result of 5-oxoproline (pyroglutamic acid): a role for acetaminophen. Clin J Am Soc Nephrol. 2006;1:441–7.

    Article  CAS  PubMed  Google Scholar 

  4. Kraut JA, Madias NE. Treatment of acute metabolic acidosis: a pathophysiologic approach. Nat Rev Nephrol. 2012;8:589–601.

    Article  CAS  PubMed  Google Scholar 

  5. Kraut JA, Madias NE. Lactic acidosis. N Engl J Med. 2014;371:2309–19.

    Article  PubMed  Google Scholar 

  6. Kraut JA, Xing SX. Approach to the evaluation of a patient with an increased serum osmolal gap and high-anion gap metabolic acidosis. Am J Kidney Dis. 2011;58:480–4.

    Article  PubMed  Google Scholar 

  7. Kraut JA, Madias NE. Metabolic acidosis: pathophysiology, diagnosis and management. Nat Rev Nephrol. 2010;6:274–85.

    Article  CAS  PubMed  Google Scholar 

  8. Hood VL. Lactic acidosis. In: Jennari FJ, Adrogué HJ, Galla JH, Madias NE, editors. Acid-base disorders and their treatment. Boca Raton: Taylor & Francis; 2005. p. 351–82.

    Google Scholar 

  9. Laski ME, Wesson DE. Lactic acidosis. In: DuBose TH Jr, Hamm LL, editors. Acid-base and electrolyte disorders. A companion to Brenner & Rector’s the Kidney. Philadelphia: Saunders; 2002. p. 83–107.

    Google Scholar 

  10. Velez JC, Janech MG. A case of lactic acidosis induced by linezolid. Nat Rev Nephrol. 2010;6:236–40.

    Article  PubMed  Google Scholar 

  11. Kang KP, Lee S, Kang SK. D-lactic acidosis in humans: review of update. Electrolyte Blood Press. 2006;4:53–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Oh MS, Halperin ML. Toxin-induced metabolic acidosis. In: Jennari FJ, Adrogué HJ, Galla JH, Madias NE, editors. Acid-base disorders and their treatment. Boca Raton: Taylor & Francis; 2005. p. 383–415.

    Chapter  Google Scholar 

  13. Wu D, Kraut JA. Role of NHE1in the cellular dysfunction of acute metabolic acidosis. Am J Nephrol. 2014;40:26–42.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer Science+Business Media LLC

About this chapter

Cite this chapter

Reddi, A.S. (2018). High Anion Gap Metabolic Acidosis. In: Fluid, Electrolyte and Acid-Base Disorders. Springer, Cham. https://doi.org/10.1007/978-3-319-60167-0_28

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-60167-0_28

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-60166-3

  • Online ISBN: 978-3-319-60167-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics