ICU SAQs · Acid–base
The differential of a high anion-gap metabolic acidosis
A differential-diagnosis question anchored on the GOLD MARK mnemonic, the dual-gap signature of toxic-alcohol poisoning, and the time-critical treatment with fomepizole and haemodialysis. Tests the discrimination between lactic, ketoacidotic, uraemic and toxic causes.
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Prompt
A 61-year-old man presents confused and unwell with a high anion-gap metabolic acidosis and an elevated osmolar gap. Discuss the differential diagnosis of a high anion-gap metabolic acidosis, the significance of the osmolar gap, and your immediate management in this patient.
Question
A 61-year-old man presents confused and unwell with a high anion-gap metabolic acidosis and an elevated osmolar gap. Discuss the differential diagnosis of a high anion-gap metabolic acidosis, the significance of the osmolar gap, and your immediate management in this patient.
References4ShowHide
- [1]Kraut JA, Madias NE. Lactic acidosis. New England Journal of Medicine, 2014.PMID 25494270
- [2]Kraut JA, Kurtz I. Toxic alcohol ingestions: clinical features, diagnosis, and management. Clinical Journal of the American Society of Nephrology, 2008.PMID 18045860
- [3]Lynd LD, Richardson KJ, Purssell RA, et al. An evaluation of the osmole gap as a screening test for toxic alcohol poisoning. BMC Emergency Medicine, 2008.PMID 18442409
- [4]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.