Chempath - Anion Gap Flashcards

1
Q

What are the causes of a raised anion gap metabolic acidosis?

A

GOLD MARK

G- Glycols (ethylene glycol and propylene glycol)
O - Oxoproline (chronic paracetamol use, usually malnourished women)
L- L-lactate (sepsis)
D- D-lactate (short gut syndrome)

M- Methanol
A- Aspirin (salicyclates)
R - Renal failure
K- Ketones

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2
Q

What acid base abnormality will salicyclate overdose cause?

A

Mixed respiratory alkalosis (drives the respiratory centre to increase ventilation) and metabolic acidosis (increased production of lactic acid and acetyl CoA)

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3
Q

What are the causes of a metabolic acidosis normal anion gap?

A

Bicarb loss replaced with chloride (normal gap)

  1. Addison’s
  2. Bicarb loss (diarrhea, laxative abuse, RTA)
  3. Chloride gain (0.9% NaCl)
  4. Drugs (acetazolamide)
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4
Q

Why does Addison’s cause normal gap metabolic acidosis?

A
  • Decreased aldosterone function
  • Decreased Na+ plasma concentration
  • Increased K+ plasma concentration

Decreased Na+ plasma reabsorption in the tubules leads to decreased H+ excretion in the tubules (acidosis)

  • Increased HCO3- excretion (due to decreased H+ reabsorption)
  • Unchanged Cl-

Overall the decrease in serum Na+ and decreased in HCO3- balance each other out and lead to a normal gap metabolic acidosis

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5
Q

How is the osmolar gap calculated?

A

2(Na+ + K+) + urea + glucose (calculated)

Minus serum osmolality

Should be <10, if >10 suggests presence of something that can’t be directly measured using tests

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