Anion gap acidosis caused

Normally, the sum of the cations exceeds the sum of the anions by no more than 12-16 mEq/L (or 8-12 mEq/L if the formula used for estimating the anion gap omits the potassium level). A larger-than expected anion gap is caused by the presence of unmeasured anions (lactate, etc) accompanying metabolic acidosis. This may occur with numerous conditions, such as diabetic ketoacidosis, renal failure, or shock-induced lactic acidosis. Drugs that may induce an elevated anion gap metabolic acidosis (Table 58-1) include aspirin, metformin, methanol, ethylene glycol, isoniazid, and iron. 

The chloride (CD) ion is the most abundant anion in the ECF (see Table 46-2), In the absence of acid-base disturbances, Cr concentrations in plasma will generally follow those of Na. However, determination of plasma CD concentration is useful in the differential diagnoses of acid-base disturbances and is essential for calculating the anion gap (see Increased Anion Gap Acidosis [Organic Acidosis] section later in this chapter). Fluctuations in serum or plasma Cl have little clinical consequence, but do serve as signs of an underlying disturbance in fluid and acid-base homeostasis and can be an aid in differentiating the cause of these disturbances. 

In contrast to high anion gap acidoses, m which bicarbonate is consumed in buffering excess the cause of acidosis in the presence of a norma anion gap is the loss of bicarbonate-rich fluid from eitlrer the kidney or gastrointestinal tract. As bicarbonate is lost, more Cl ions are reabsorbed with Na or to maintain electrical neutrality so that hyperchloremia ensues (see Figure 46-14). Normal anion gap acidosis can be divided into hypokalemic and normokalemic acidoses, which can be helpful in the differential diagnosis of this type of disorder (see Table 46-4). 

Clove oil Contains 80-90% eugenoi. Anion gap acidosis and CNS depression after acute ingestion. Ciove cigareties may cause irritant tracheobronchitis, hemoptysis. 

B. Ingestion of fomtaldehyde solutions may cause severe corrosive esophageal and gastric injury, depending on the concentration. Lethargy and coma have been reported. Metabolic (anion gap) acidosis may be caused by formic acid accumulation from metabolism of formaldehyde or methanol. 

Metabolic acidosis is characterized by a decrease in serum HC03. The anion gap is used to narrow the differential diagnosis, as this acidosis may be caused by addition of acids (increased anion gap) or loss of HC03 (normal anion gap). The compensation for metabolic acidosis is an increase in ventilation with a decrease in arterial C02. 

Anion gap can be calculated to elucidate the cause of metabolic acidosis (T able 74-3). The anion gap is calculated as follows ... 

Methanol and ethylene glycol are contaminants of illicit ethanol, and can be taken as ethanol substitutes. Both agents cause severe metabolic acidosis with a high anion gap. 

Although there is a long list of causes of metabolic acidosis with an increased anion gap (286,287), clinical clues can help diagnosis. A case report has illustrated the acute metabolic and hemodynamic effects of ingestion of a massive load of oral citric acid. The principal findings included a metabolic acidosis accompanied by an increase in the plasma anion gap, not due to lactic acidosis, hyperkalemia, and the abrupt onset of hypotension (288). 

---