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Metabolic Acidosis Mnemonic

Acidosis | 5-minute Emergency Consult

Acidosis | 5-minute Emergency Consult

Type your tag names separated by a space and hit enter Reduced pH owing to alveolar hypoventilation with elevated PaCO2 Defined as PaCO2 >45 mm Hg or higher than expected for calculated respiratory compensation for metabolic acidosis Primary failure in CNS drive to ventilate: Primary failure in transport of CO2 from alveolar space: Primary failure in transport of CO2 from tissue to alveoli: Process that reduces serum pH by decreasing plasma bicarbonate levels Accumulation of a strong acid through ingestion or metabolism Metabolic acidosis is clinically evaluated by dividing into 2 main groups: Bicarbonate reduced through buffering of added strong acid Anion gap is increased due to retention of the unmeasured anion from the titrated strong acid. Normal anion gap metabolic acidosis due to: Kidneys fail to reabsorb or regenerate bicarbonate. Losses of bicarbonate from GI tract (diarrhea) Ingestion or infusion of substances that release hydrochloric acid No anion gap is observed owing to the absence of any unmeasured anion of a titrated acid and secondary chloride retention with HCO3 loss. Anion gap acidosis: Mnemonic A CAT PILES MUD: Removal of small bowel, pancreatic or biliary secretions Anion exchange resins (i.e., cholestyramine) Ingestion of calcium chloride or magnesium chloride Type I renal tubular acidosis (distal): Hypokalemic hyperchloremic metabolic acidosis: Type II renal tubular acidosis (proximal): Hypokalemic hyperchloremic metabolic acidosis: Acidosis limited by reabsorptive capacity of proximal tubule for HCO3 Type IV renal tubular acidosis (hypoaldosteronism): Hyperkalemic hyperchloremic acidosis: Aldosterone deficiency or resistance causing decreased H+ secretion Tachypnea or Kussmaul respirations with metabolic acidosis Hypoventilation with respiratory Continue reading >>

Gold Mark: An Anion Gap Mnemonic For The 21st Century

Gold Mark: An Anion Gap Mnemonic For The 21st Century

A Lancet Editorial1 in 1977, referring to an article entitled “Clinical use of the anion gap”2 opined: “In an age when all too often plasma-electrolyte measurements are ordered without any deliberate judgment being made as to the likely usefulness of the result, it is refreshing to have a reminder of the subtleties involved in the interpretation of this commonest set of clinical-chemistry tests”. We have discovered some new twists over the past 30 years and would like to share an easily remembered mnemonic aid. The metabolic acidoses are generally separated into two categories on the basis of an anion gap calculation (Na+[Cl−HCO3−]): the high-anion-gap metabolic acidoses, and the normal-anion-gap, or hyperchloraemic, metabolic acidoses. Two popular mnemonics are often used to remember the major causes of the high-gap metabolic acidoses. The first is KUSMALE (a useful misspelling of Adolph Kussmaul's name), which represents Ketoacidosis, Uraemia, Salicylate poisoning, Methanol, Aldehyde (paraldehyde), Lactate, and Ethylene glycol. The second is MUD PILES, representing Methanol, Uraemia, Diabetes, Paraldehyde, Iron (and Isoniazid), Lactate, Ethylene glycol, and Salicylate. Metabolic acidosis due to excessive paraldehyde use has become exceedingly rare. Iron and isoniazid are just two of many drugs and toxins that cause hypotension and lactic acidosis (isoniazid can also generate a component of ketoacidosis). Three “new” organic anion-gap-generating acids and acid precursors have been recognised in recent years. They are D-lactic acid, which can occur in some patients with short bowel syndromes; 5-oxoproline (or pyroglutamic acid) associated with chronic paracetamol use, often by malnourished women; and the anion-gap acidosis generated by high-dose propylen Continue reading >>

The New Goldmark Mnemonic For Anion Gap Metabolic Acidosis From Em Cases

The New Goldmark Mnemonic For Anion Gap Metabolic Acidosis From Em Cases

This is the link to Best Case Ever 56 Anion Gap Metabolic Acidosis [link is to the podcast and shownotes] from Emergency Medicine Cases . The case discussion of a 65 yr old woman who presented to the emergency department appearing only mildly ill clinically but turned out to have complex metabolic derangements. The case discussion is approximately 21 minutes long and totally worth listening to. But this post is just about the GOLDMARK mnemonic for differential diagnosis of metabolic acidosis AND aboutthe differential diagnosis of an osmolar gap. Anion gap = [Na +] ([Cl -] + [HCO 3 ]) (normal is 12 2) from General Formulas of emedicine.medscape.com Osmolal gap = measured osmoles calculated osmoles (normal is < 10) from General Formulas of emedicine.medscape.com [Calculated] Osmoles = (2 x [Na +]) + (glucose/18) + (BUN/2.8) + (ethanol/4.6)from General Formulas of emedicine.medscape.com In addition to d-lactate, the D in GOLDMARK can stand for drugs and an article that discussesdrugs causing metabolic acidosis isDrug-Induced Metabolic Acidosis [ PubMed Abstract ] [ Full Text HTML ] [ Full Text PDF ].F1000Res. 2015 Dec 16;4. pii: F1000 Faculty Rev-1460. doi: 10.12688/f1000research.7006.1. eCollection 2015. What follows below is extract from the show notes that is contains a review of the new mnemonic for anion gap metabolic acidosis -GOLDMARK and a review of the osmolar gap differential diagnosis: The MUDPILES mnemonic for anion gap metabolic acidosis is out of date Metabolic acidosis due to paraldehyde overdose is exceedingly rare Iron and isoniazid are just two of many drugs and toxins that cause hypotension and lactic acidosis (isoniazid can also generate a component of ketoacidosis). Three newer anion-gap-generating acids have been recognised recently: D-lactic acid, w Continue reading >>

Acid-base Differential Diagnosis

Acid-base Differential Diagnosis

This patient's elevated blood pH and decrease in PaCO2 is consistent with acute respiratory alkalosis. Respiratory acid-base disorders are caused by primary changes in PaCO2, whereas metabolic acid-base disorders are due to primary changes in the concentration of HCO3-. A primary rise in PaCO2 or a fall in plasma HCO3- reduces the pH (acidemia), whereas the opposite increase the pH (alkalemia). Patients suffering from pneumonia can have tachypnea due to hypoxia. Increased minute ventilation reduces arterial CO2, an acid, resulting in alkalosis. A slight decrease in bicarbonate level may be seen due to early renal compensation. Answer 1: Normal pH range is 7.35-7.45. This patient's pH is outside this range, which indicates an acid-base disturbance. Answer 2: A decreased pH and an decrease in HCO3- would be consistent with metabolic acidosis. Answer 3: An elevated pH and an increase in HCO3- would be consistent with metabolic alkalosis. Answer 4: Respiratory acidosis results from decreased alveolar ventilation, which causes increased arterial CO2 levels. Continue reading >>

Medical Mnemonics: Causes Of Anion Gap Metabolic Acidosis – “gold Mark”

Medical Mnemonics: Causes Of Anion Gap Metabolic Acidosis – “gold Mark”

The classic mnemonic often used to remember the causes of anion gap metabolic acidosis is “MUDPILES” M – Methanol U – Uremia D – Diabetic ketoacidosis P – Propylene Glycol I – Isoniazid L – Lactic Acidosis E – Ethylene Glycol S – Salicylates More recently a new mnemonic has been suggested to update new our understanding of anion-gap generating acids. The updated mnemonic “GOLD MARK” was proposed in a 2008 article in The Lancet. G – Glycols (ethylene glycol and propylene glycol) O – Oxoproline L – L-Lactate D – D-Lactate M – Methanol A – Aspirin R – Renal Failure K – Ketoacidosis As medicine evolves, so do our Mnemonics. This is the fifth medical mnemonic in our series of Monday Mnemonics. Continue reading >>

Normal Anion Gap Metabolic Acidosis

Normal Anion Gap Metabolic Acidosis

Home | Critical Care Compendium | Normal Anion Gap Metabolic Acidosis Normal Anion Gap Metabolic Acidosis (NAGMA) HCO3 loss and replaced with Cl- -> anion gap normal if hyponatraemia is present the plasma [Cl-] may be normal despite the presence of a normal anion gap acidosis -> this could be considered a ‘relative hyperchloraemia’. Extras – RTA, ingestion of oral acidifying salts, recovery phase of DKA loss of bicarbonate with chloride replacement -> hyperchloraemic acidosis secretions into the large and small bowel are mostly alkaline with a bicarbonate level higher than that in plasma. some typical at risk clinical situations are: external drainage of pancreatic or biliary secretions (eg fistulas) this should be easily established by history normally 85% of filtered bicarbonate is reabsorbed in the proximal tubule and the remaining 15% is reabsorbed in the rest of the tubule in patients receiving acetazolamide (or other carbonic anhydrase inhibitors), proximal reabsorption of bicarbonate is decreased resulting in increased distal delivery and HCO3- appears in urine this results in a hyperchloraemic metabolic acidosis and is essentially a form of proximal renal tubular acidosis but is usually not classified as such. hyperchloraemic metabolic acidosis commonly develops during therapy of diabetic ketoacidosis with normal saline oral administration of CaCl2 or NH4Cl is equivalent to giving an acid load both of these salts are used in acid loading tests for the diagnosis of renal tubular acidosis CaCl2 reacts with bicarbonate in the small bowel resulting in the production of insoluble CaCO3 and H+ the hepatic metabolism of NH4+ to urea results in an equivalent production of H+ REASONS WHY ANION GAP MAY BE NORMAL DESPITE A ‘HIGH ANION GAP METABOLIC ACIDOSIS’ 1. Continue reading >>

The Anion Gap

The Anion Gap

The anion gap is a tool used to: Confirm that an acidosis is indeed metabolic Narrow down the cause of a metabolic acidosis Monitor the progress of treatment In a metabolic acidosis the anion gap is usually either ‘Normal’ or ‘High’. In rare cases it can be ‘low’, usually due to hypoalbuminaemia. An ABG machine will often give a print out of the anion gap, but it can also be useful to know how it is calculated. In blood, there are many cations and anions. However, the vast majority of the total number are potassium, sodium, chloride, or bicarbonate. The ‘anion’ gap is an artificial measure, which is calculated by subtracting the total number of anions (negatively charged ions – bicarbonate and chloride) from the total number of cations (sodium and potassium). Thus, the formula is: ([Na+]+ [K+]) –([Cl–]+ [HCO3–]) In reality, the concentration of potassium anions is negligible, and this often omitted. There are usually more measurable cations than anions, and thus a normal anion gap is value is positive. A normal value is usually 3-16, but may vary slightly depending on the technique used by the local laboratory. If the anion gap is <30, then there may not be ‘true’ high anion gap metabolic acidosis. In a healthy normal individual, the main unmeasured anions are albumin and phosphate. Almost all of the gap can be attributed to albumin. This means that in patients with hypoalbuminaemia and metabolic acidosis, there may be a normal anion gap. Be wary in severely unwell patients because they often have a low albumin. You can adjust for this in your calculation. Corrected anion gap: [AG] + (0.25 x (40-albumin)) In an unwell patient with a high anion gap metabolic acidosis (HAGMA) the anion gap is increased due: Accumulation of organic acids Inabili Continue reading >>

Metabolic Muddle Litfl Clinical Cases Catmudpiles

Metabolic Muddle Litfl Clinical Cases Catmudpiles

The first step: is the patient acidaemic or alkalaemic? The second step: is there a metabolic acidosis or a respiratory acidosis or both? The third step: is there appropriate compensation? The estimated expected CO2 is 1.5xHCO3 + 8 i.e. approximately 13 so its pretty close The fourth step: what is the nature of the metabolic acidosis? The anion gap is markedly elevated at 35 [(Na+ K+) (Cl-+HCO3-)] The fifth step: is there a coexistent normal anion gap acidosis or pre-existing metabolic alkalosis? If the high anion gap acidosis is the only metabolic disturbance, the bicarbonate drops by the same degree that the anion gap rises. In this case, assuming a normal anion gap of 12, the anion gap has increased by 23 while the HCO3- has decreased by 23.Assuming a normal HCO3- of 26 the bicarbonate has decreased by 23 to finish up at 3. So the high anion gap metabolic acidosis is the only metabolic disturbance. If the bicarbonate drops less than anticipated, it must have started off at a higher level than you normally expect (i.e. there must be a pre-existing metabolic alkalosis) If the bicarbonate drops more than anticipated, there must be another source of acidosis (i.e. a co-existent normal anion gap acidosis) Continue reading >>

Best Case Ever 56 Anion Gap Metabolic Acidosis

Best Case Ever 56 Anion Gap Metabolic Acidosis

In this month’s Best Case Ever on EM Cases Dr. Ross Claybo and Dr. Keerat Grewal tell the story of a patient with a complicated anion gap metabolic acidosis. We discuss how to sort through the differential diagnosis with a better mnemonic than MUDPILES, the controversy around administering sodium bicarbonate for metabolic acidosis, the indications for fomepizole and the value of taking time to to build a therapeutic relationship with your ED patients. Podcast production and sound design by Anton Helman. Show notes by Anton Helman, March 2017 The MUDPILES mnemonic for anion gap metabolic acidosis is out of date Why? Metabolic acidosis due to paraldehyde overdose is exceedingly rare Iron and isoniazid are just two of many drugs and toxins that cause hypotension and lactic acidosis (isoniazid can also generate a component of ketoacidosis). Three “newer” anion-gap-generating acids have been recognised recently: D-lactic acid, which can occur in some patients with short bowel syndromes. 5-oxoproline (or pyroglutamic acid) associated with chronic acetaminophen use. Propylene glycol infusions – solvent used for several IV medications including lorazepam and phenobarbital. The GOLDMARK mnemonic for anion gap metabolic acidosis is more useful GOLDMARK mnemonic for anion gap metabolic acidosis Glycols (ethylene glycol & propylene glycol) Oxoproline (metabolite of acetaminophen) L-lactate D-lactate (acetaminophen, short bowel syndrome, propylene glycol infusions for lorazepam and phenobarbital) Methanol ASA Renal Failure Ketoacidosis (starvation, alcohol and DKA) Osmolar Gap common differential diagnosis Ketoacids (DKA, AKA, starvation ketosis) Alcohols Sepsis Ischemia Sodium bicarbonate for metabolic acidosis: Still controversial The indcations for sodium bicarb for metab Continue reading >>

High Anion Gap Metabolic Acidosis

High Anion Gap Metabolic Acidosis

When acidosis is present on blood tests, the first step in determining the cause is determining the anion gap. If the anion gap is high (>12 mEq/L), there are several potential causes. High anion gap metabolic acidosis is a form of metabolic acidosis characterized by a high anion gap (a medical value based on the concentrations of ions in a patient's serum). An anion gap is usually considered to be high if it is over 12 mEq/L. High anion gap metabolic acidosis is caused generally by acid produced by the body,. More rarely, high anion gap metabolic acidosis may be caused by ingesting methanol or overdosing on aspirin.[1][2] The Delta Ratio is a formula that can be used to assess elevated anion gap metabolic acidosis and to evaluate whether mixed acid base disorder (metabolic acidosis) is present. The list of agents that cause high anion gap metabolic acidosis is similar to but broader than the list of agents that cause a serum osmolal gap. Causes[edit] Causes include: The newest mnemonic was proposed in The Lancet reflecting current causes of anion gap metabolic acidosis:[3] G — glycols (ethylene glycol & propylene glycol) O — oxoproline, a metabolite of paracetamol L — L-lactate, the chemical responsible for lactic acidosis D — D-lactate M — methanol A — aspirin R — renal failure K — ketoacidosis, ketones generated from starvation, alcohol, and diabetic ketoacidosis The mnemonic MUDPILES is commonly used to remember the causes of increased anion gap metabolic acidosis.[4][5] M — Methanol U — Uremia (chronic kidney failure) D — Diabetic ketoacidosis P — Paracetamol, Propylene glycol (used as an inactive stabilizer in many medications; historically, the "P" also stood for Paraldehyde, though this substance is not commonly used today) I — Infectio Continue reading >>

Solution To

Solution To "a Disoriented, Nauseated Car Wreck Victim"

Solution to "A Disoriented, Nauseated Car Wreck Victim" This is the solution to a case we presented recently. You may review the case at The patient has an increased anion gap acidosis. 2. Delta gap calculation = (observed gap - expected gap) + observed bicarbonate = (33 - 12) + 5 = 26. Thus, the patient started out with a normal bicarbonate (this excludes an underlying metabolic acidosis or alkalosis). 3. Winter's equation = 1.5 (calculated bicarbonate) + 8 (+ or -) 2 [expected pCO2] = 1.5 (2) + 8 = 11. This suggests that the hyperventilation is appropriate for the degree of metabolic acidosis. We use the mnemonic KILU for remembering the differential of anion gap acidosis: Ketoacidoses (diabetic, alcoholic, starvation) Ingestions (salicylates, ethylene glycol, methanol and, less commonly, iron and isoniazid) Anion gaps > 25 occur primarily with diabetic ketoacidosis, lactic acidosis, ethylene glycol, and methanol. In consideration of the stable vital signs and normal blood sugar, the physicians appropriately considered an ingestion. They ordered a serum osmolality. This supports a likely ingestion with either ethylene glycol or methanol. The positive calcium oxalate crystals made the likely diagnosis ethylene glycol toxicity, which laboratory data confirmed. Laboratory testing excluded lactic acidosis, methanol toxicity, salicylate toxicity, and ketoacidosis. After the patient's mental status returned to normal, he admitted to drinking "moonshine" liquor in large amounts. We assume (but cannot be certain) that the moonshine had ethylene glycol added (to provide a sweet taste). Treatment: The patient received fomepizole (an alcohol dehydrogenase inhibitor) and dialysis. He subsequently developed nonoliguric acute renal failure, which resolved over 1 week, at which tim Continue reading >>

Metabolic Acidosis Nclex Review Notes

Metabolic Acidosis Nclex Review Notes

Are you studying metabolic acidosis and need to know a mnemonic on how to remember the causes? This article will give you a clever mnemonic and simplify the signs and symptoms and nursing interventions on how to remember metabolic acidosis for nursing lecture exams and NCLEX. In addition, you will learn how to differentiate metabolic acidosis from metabolic alkalosis. Don’t forget to take the metabolic acidosis and metabolic alkalosis quiz. This article will cover: Metabolic acidosis simplified Lab values expected with metabolic acidosis Causes of metabolic acidosis Signs and symptoms of metabolic acidosis Nursing interventions for metabolic acidosis Lecture on Metabolic Acidosis Metabolic Acidosis Metabolic Acidosis in Simple Terms: a metabolic problem due to the buildup of acid in the body fluids which affects the bicarbonate (HCO3 levels) either from: increased acid production (ex: DKA where ketones (acids) increase in the body which decreases bicarbonate) decreased acid excretion (ex: renal failure where there is high amount of waste left in the body which causes the acids to increase and bicarb can’t control imbalance) loss of too much bicarb (diarrhea) When this acidic phenomena is taking place in the body other systems will try to compensate to increase the bicarb back to normal. One system that tries to compensate is the respiratory system. In order to compensate, the respiratory system will cause the body to hyperventilate by increasing breathing through Kussmaul’s respirations. Kussmaul respirations are deep, rapid breathes. The body hopes this will help expel CO2 (an acid) which will “hopefully” increase the pH back to normal. Lab values expected in Metabolic Acidosis: HCO3: decreased <22 Blood pH: decreased <7.35 CO2: <35 or normal (may be normal b Continue reading >>

File:cat Mudpiles - Causes Of High Anion-gap Metabolic Acidosis.svg

File:cat Mudpiles - Causes Of High Anion-gap Metabolic Acidosis.svg

File:Cat mudpiles - causes of high anion-gap metabolic acidosis.svg DescriptionCat mudpiles - causes of high anion-gap metabolic acidosis.svg English: Causes of high anion-gap metabolic acidosis Diabetic ketoacidosis, Alcoholic ketoacidosis, Starvation ketoacidosis Paracetamol/Acetaminophen, Phenformin, Paraldehyde Iron, Isoniazid, Inborn errors of metabolism Ethanol (due to lactic acidosis), Ethylene glycol This SVGdiagram uses embedded textthat can be easily translated using a text editor. Learn more . I, the copyright holder of this work, hereby publish it under the following license: This file is made available under the Creative Commons CC0 1.0 Universal Public Domain Dedication . The person who associated a work with this deed has dedicated the work to the public domain by waiving all of his or her rights to the work worldwide under copyright law, including all related and neighboring rights, to the extent allowed by law. You can copy, modify, distribute and perform the work, even for commercial purposes, all without asking permission. Commons Zero, Public Domain Dedicationfalsefalse Click on a date/time to view the file as it appeared at that time. This file contains additional information such as Exif metadata which may have been added by the digital camera, scanner, or software program used to create or digitize it. If the file has been modified from its original state, some details such as the timestamp may not fully reflect those of the original file. The timestamp is only as accurate as the clock in the camera, and it may be completely wrong. Continue reading >>

High Anion Gap Metabolic Acidosis - Hagma

High Anion Gap Metabolic Acidosis - Hagma

High Anion Gap Metabolic Acidosis - HAGMA Simply put, High Anion Gap Metabolic Acidosis (HAGMA) is a type of metabolic acidosis caused by a high anion gap usually situated above 12 mEq/L. Metabolic acidosis can be categorized as either high or normal anion gap based on the presence or absence of unmeasured anions in serum. In general, it is caused by an accumulation of acid components within serum. Usually due to; Increased acid production or acid indigestion With the help of this formula, we can better understand the relationship between the anions and the cations which are responsible for the calculation of the gap itself In general, the balance between the anions (negativeions)and the cations(positive ions) is kept neutral. In other words, the electrical charge between theanions and cations are in equilibrium. In daily practice, potassium (K+) is often left out during the calculation due to the very low concentrations of it. Therefore the most used equation is; Keep in mind that the gap is calculated according to how many ions arenotaccounted for by the lab measurements (seen in the above equation). A normal serum anion gap is usually kept anywhere between 6 - 12mEq/L however due to some amount of unmeasurable anions (margin of error) anything lower than 11 mEq/L is considered normal. A healthy subject should present, with an anion gap of 0 to slightly normal of <10 mEq/L. Anion gap is commonly performedforpatients that present with altered mental status, unknown exposure, acute renal failure and acute illnesses. It helps provide a possible differential diagnosis in certain situations. The most common causes of HAGMA related to the accumulation of acid are; Other causes are responsible for normal anion gap acidosis which is typically related directly to the kidneys. Continue reading >>

Metabolic Acidosis

Metabolic Acidosis

Diabetic Ketoacidosis (DKA), Alcohol ic ketoacidosis or starvation ketosis Paraldehyde, Phenformin (neither used in U.S. now) Propofol Infusion Syndrome has been proposed as a replacement in mnemonic Salicylate s (do not miss Chronic Salicylate Poisoning ) IV. Causes: Metabolic Acidosis and Normal Anion Gap (Hyperchloremia) Renal Tubular Acidosis (proximal or distal) V. Causes: Metabolic Acidosis and Elevated Osmolal Gap PaCO2 drops 1.2 mmHg per 1 meq/L bicarbonate fall Calculated PaCO2 = 1.5 x HCO3 + 8 (+/- 2) Useful in High Anion Gap Metabolic Acidosis Measured PaCO2 discrepancy: respiratory disorder Investigate normal Anion Gap Metabolic Acidosis Elevated in normal Anion Gap Metabolic Acidosis VII. Labs: Consider in Metabolic Acidosis with Increased Anion Gap Basic chemistry panel as above ( Serum Glucose , Blood Urea Nitrogen ) Rutecki (Dec 1997) Consultant, p. 3067-74 Images: Related links to external sites (from Bing) These images are a random sampling from a Bing search on the term "Metabolic Acidosis." Click on the image (or right click) to open the source website in a new browser window. Search Bing for all related images Related Studies (from Trip Database) Open in New Window A condition in which the blood is too acidic. It may be caused by severe illness or sepsis (bacteria in the bloodstream). Increased acidity in the blood secondary to acid base imbalance. Causes include diabetes, kidney failure and shock. ACIDOSIS METABOLIC, metabolic acidosis, metabolic acidosis (diagnosis), Acidosis metabolic, Metabolic acidosis NOS, Metabolic Acidoses, Acidosis, Metabolic, Acidoses, Metabolic, Metabolic Acidosis, acidosis metabolic, metabolic acidosis disorder, Acidosis, Metabolic acidosis (disorder), acidosis; metabolic, metabolic; acidosis, Metabolic acidosis, NOS, M Continue reading >>

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