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High anion gap metabolic acidosis is a form of metabolic acidosis characterized by a high anion gap (a medical value based on the concentrations of ions in a patient’s serum). An anion gap is usually considered to be high if it is over 11 mEq/L.

G — glycols (ethylene glycol & propylene glycol)
O — oxoproline, a metabolite of paracetamol
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


M — Methanol
U — Uremia (chronic kidney failure)
D — Diabetic ketoacidosis
P — Paraldehyde
I — Infection, Iron, Isoniazid, Inborn errors of metabolism
L — Lactic acidosis
E — Ethylene glycol
S — Salicylates

Ingestion of ethylene glycol (commonly used in antifreeze) leads to a metabolic acidosis and severe damage to the central nervous system, heart, lungs, and kidneys. The increased anion gap and osmolar gap are attributable to ethylene glycol and its metabolites, oxalic acid, glycolic acid, and other organic acids.

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