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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). Metabolic acidosis occurs when the body produces too much acid , or when the kidneys are not removing enough acid from the body.
The anion gap is the quantity difference between cations (positively charged ions) and anions (negatively charged ions) in serum, plasma, or urine. The magnitude of this difference (i.e., "gap") in the serum is calculated to identify metabolic acidosis. If the gap is greater than normal, then high anion gap metabolic acidosis is diagnosed.
Elevated protein (albumin, globulins) may theoretically increase the anion gap but high levels are not usually encountered clinically. Hypoalbuminaemia, which is frequently encountered clinically, will mask an anion gap. As a rule of thumb, a decrease in serum albumin by 1 G/L will decrease the anion gap by 0.25 mmol/L [citation needed]
English: Causes of high anion-gap metabolic acidosis Mnemonic "CAT MUDPILES": Carbon monoxide, Cyanide, Congenital; heart failure Aminoglycosides; Teophylline, Toluene (Glue-sniffing)
Urine NH 4 + is difficult to measure directly, but its excretion is usually accompanied by the anion chloride. A negative urine anion gap can be used as evidence of increased NH 4 + excretion. In a metabolic acidosis without a serum anion gap: A positive urine anion gap suggests a low urinary NH 4 + (e.g. renal tubular acidosis).
When this happens the numerator is large, the denominator is small, and the result is a delta ratio which is high (>2). This means a combined high anion gap metabolic acidosis and a pre-existing either respiratory acidosis or metabolic alkalosis (causing the high bicarbonate) – i.e. a mixed acid–base metabolic acidosis. [citation needed]
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The mnemonic "MUDPILES" is used to remember the causes of a high anion gap. [ 1 ] M - methanol / metformin U - uremia D - diabetic ketoacidosis P - paraldehyde / propylene glycol I - Infection / ischemia / isoniazid L - lactate E - ethylene glycol / ethanol S - salicylates / starvation