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High anion gap metabolic acidosis is a form of metabolic acidosis characterized by a high anion gap. High anion gap Metabolic acidosis mnemonic “GOLD MARK”

G – Glycols (ethylene glycol, propylene glycol)

O – Oxoproline (pyroglutamic acid, the toxic metabolite of excessive acetaminophen or paracetamol)

L-Lactate (standard lactic acid seen in lactic acidosis)

D- D-Lactate (exogenous lactic acid produced by gut bacteria)

M – Methanol (this is inclusive of alcohols in general)

A – Aspirin (salicylic acid)

R – Renal Failure (uremic acidosis)

K – Ketones (diabetic, alcoholic and starvation ketosis)

High anion gap Metabolic acidosis mnemonic
High anion gap Metabolic acidosis mnemonic

The acronym MUDPILES is often used as a memory aid to recall the potential causes of an elevated anion gap in metabolic acidosis.

M — Methanol

U — Uremia (chronic kidney failure)

D — Diabetic ketoacidosis

P — Paracetamol, Propylene glycol

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 (Note: Sometimes, we also include ethanol in this mnemonic, but it causes acidosis primarily by increasing lactic acid production during intoxication)

S — Salicylates

Another frequently used mnemonic is KARMEL

K — Ketoacidosis

A — Aspirin

R — Renal failure

M — Methanol

E — Ethylene glycol

L — Lactic acidosis

Other mnemonics you may find helpful:

Anatomy medical mnemonics

Pharmacology mnemonics

Dementia mnemonic

Alzheimer’s disease mnemonic

DiGeorge syndrome mnemonic

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