Case of the Month #44 High Anion Gap Metabolic Acidosis

Published 12/10/2023

Take home messages:

  • A broad differential exists when a patient presents with undifferentiated shock.
  • The clinical history and medical/drug history provide vital information.
  • There are numerous causes of a high anion gap metabolic acidosis (HAGMA). More than one cause may be present.
  • ‘GOLDMARK’ and ‘MUDPILES’ are useful mnemonics to remember causes of HAGMA.
  • Derangements of albumin should be corrected for, otherwise calculation of the anion gap may be erroneous.
  • Newer oral hypoglycaemic agents such as the SGLT2-inhibitors may delay diagnosis of diabetic ketoacidosis, as hyperglycaemia may not be present.