13 Anion Gap Metabolic Acidosis

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