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13 Anion Gap Metabolic Acidosis

13 Anion Gap Metabolic Acidosis

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Published by Joel Topf

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Published by: Joel Topf on Oct 26, 2009
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11/21/2012

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325
S. Faubel and J. Topf13 Metabolic Acidosis: Anion Gap
13
 Metabolic Acidosis:13 Anion Gap
 
326
The Fluid, Electrolyte and Acid-Base Companion
Introduction
Addition of acid causes metabolic acidosis with anincreased anion gap.
 Anion gap metabolic acidosis is due to the addition of acid. Addition of acid raises the hydrogen ion concentration (lowers pH). The increase in hy-drogen then causes the following:
Decreased bicarbonate
. Added hydrogen is buffered by bi-carbonate, lowering the bicarbonate concentration.
Increased anion gap
. As acid is added, the accompanyinganion accumulates in the plasma, increasing the anion gap.Chloride concentration does not change.
HCO
3
H
+
HCO
3
H
+
C
HCO
3
H
+
HCO
3
H
+
C
cations==anions
Na
+
K
+
anionscations
Na
+
K
+
HCO
3
Cl
 –
A
-
otheranions
HCO
3
Cl
 –
A
-
otheranions
The addition of hydro-gen ions lowers pH. Bi-carbonate is consumedbuffering the added hy-drogen.
HCO
3 –
The anions associatedwith the acid increasethe anion gap. Chlorideconcentration is un-changed.
Gap
 Anion gap metabolic acidosis is due to the addition of ______.In anion gap metabolic acidosis, the bicarbonate _________ (de-creases/increases) because it is consumed buffering hydrogen.In metabolic acidosis due to the addition of acid, the accumula-tion of _________ causes the ________ gap to increase.aciddecreasesanions, anion
The difference between anion and non-anion gap metabolic acidosis is discussed in Chap-ter 11,
MetabolicAcidosis: The Overview.
 
327
S. Faubel and J. Topf13 Metabolic Acidosis: Anion Gap
Introduction
Anion gap metabolic acidosis is caused by fourfundamental processes.
 Anion gap metabolic acidosis is due to one of four fundamental processes:lactic acidosis, ketoacidosis, renal failure or ingestions. Every third yearmedical student learns a mnemonic for the differential diagnosis of aniongap metabolic acidosis; we learned PLUM SEEDS:
P
araldehyde...............................................Ingestion
L
actic Acidosis............................................Lactic acidosis
U
remia........................................................Renal Failure
M
ethanol.....................................................Ingestion
S
alicylate poisoning...................................Ingestion
E
thanol.......................................................Ketoacidosis
E
thylene glycol...........................................Ingestion
D
KA............................................................Ketoacidosis
S
tarvation...................................................Ketoacidosis
 Anion gap metabolic acidosis is caused by one of four funda-mental processes:_____________, _____________, _____________, _____________ A good mnemonic is _________________.lactic acidosisketoacidosisrenal failureingestionsPLUM SEEDS
increased anion gap
Ingestions
CCOOCH
3
CH
2
OOCCHOCH
3
CH
2
OOHCH
3
CH
3
C
Ketoacidosis
R
.
I  
.
P   
Renal failureLactic acidosis
=anions cations
Na
+
K
+
HCO
3
Cl
 –
A
-
otheranions
Oxygen

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