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)