Which conditions are associated with high anion gap (AG) metabolic acidosis?

Updated: Dec 08, 2020
  • Author: Christie P Thomas, MBBS, FRCP, FASN, FAHA; Chief Editor: Vecihi Batuman, MD, FASN  more...
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High AG metabolic acidosis warrants consideration of the following:

  • Lactic acidosis – L-lactate, D-lactate

  • Ketoacidosis - Beta-hydroxybutyrate, acetoacetate

  • Chronic kidney disease (CKD) - High-AG chronic metabolic acidosis is seen in later stages of CKD, as a result of loss of nephron mass and impaired glomerular elimination of organic acid residues [7]

  • Ingestions - Salicylate, methanol or formaldehyde (formate), ethylene glycol (glycolate, oxalate), paraldehyde (organic anions), phenformin/metformin [8]

  • Infusions - Propylene glycol (D-lactate, L-lactate)

  • Pyroglutamic acid (5-oxoprolinemia) - Typically seen in malnourished, chronically ill women with a history of long-term acetaminophen ingestion [9]

  • Massive rhabdomyolysis (release of H+ and organic anions from damaged muscle)

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