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

Updated: Oct 10, 2018
  • Author: Christie P Thomas, MBBS, FRCP, FASN, FAHA; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Answer

High AG warrants consideration of the following:

  • Lactic acidosis – L-Lactate, D-lactate

  • Ketoacidosis - Beta-hydroxybutyrate, acetoacetate

  • Renal failure - Sulfate, phosphate, urate, and hippurate

  • Ingestions - Salicylate, methanol or formaldehyde (formate), ethylene glycol (glycolate, oxalate), paraldehyde (organic anions), phenformin/metformin [5]

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

  • Pyroglutamic acidemia (5-oxoprolinemia)

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


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