Case of the Month #44 High Anion Gap Metabolic Acidosis

Published 12/10/2023

What are the causes of a high anion gap metabolic acidosis (HAGMA)?

Many causes of HAGMA exist. Two useful mnemonics to consider are:

‘GOLDMARK’ ‘MUDPILES’
Glycols (propylene glycol, ethylene glycol) Methanol
Oxoproline (chronic paracetamol use) Uraemia
L-lactate         Diabetic ketoacidosis
D-lactate (short bowel syndrome) Paraldehyde
Methanol Iron, isoniazid
Aspirin Lactic acid
Renal failure   Ethanol, ethylene glycol, propylene glycol
Ketoacidosis   Salicylates