Correct!
5. All of the above

A mnemonic commonly used to remember the causes of a high anion gap metabolic acidosis is “goldmark” where-
G — glycols (ethylene glycol & propylene glycol)
O — oxoproline, a metabolite of paracetamol / acetaminophen
L — L-lactate, the chemical responsible for lactic acidosis
D — D-lactate
M — methanol
A — aspirin
R — renal failure
K — ketoacidosis, ketones generated from starvation, alcohol, and diabetic ketoacidosis.

“Mudpiles” is another commonly used mnemonic for high anion gap metabolic acidosis where-
M — Methanol
U — Uremia (chronic kidney failure)
D — Diabetic ketoacidosis
P — Paracetamol, Propylene glycol (used as an inactive stabilizer in many medications; historically, the "P" also stood for Paraldehyde, though this substance is not commonly used today)
I — Infection, Iron, Isoniazid (which can cause lactic acidosis in overdose), Inborn errors of metabolism (an especially important consideration in pediatric patients)
L — Lactic acidosis
E — Ethylene glycol
S — Salicylates

Working through “MUDPILES” a number of metabolic parameters were measured including-

Methanol-methanol level normal
Uremia-BUN normal
Diabetic ketoacidosis- beta hydroxybutyrate 9.47 mmol/L (normal < 0.5), urine ketones 2+, blood glucose 123 mg/dL (normal < 125).
Lactate 0.4 mmol/L (normal <2.2)
Salicylates-undetectable

Which of the following most likely accounts for the patient’s acidosis? (Click on the correct answer to be directed to the fifth and final page)

  1. Diabetic ketoacidosis
  2. Ethanol intoxication
  3. Ethylene glycol poisoning
  4. Lactic acidosis from sepsis syndrome
  5. Starvation ketosis

Home/Critical Care