HIGH ANION GAP METABOLIC ACIDOSIS

Course overview

HIGH ANION GAP METABOLIC ACIDOSIS (HAGMA) IS A TYPE OF METABOLIC ACIDOSIS. DIFFERENTIATION OF ACIDOSIS INTO A PARTICULAR SUBTYPE, WHETHER HIGH ANION GAP METABOLIC ACIDOSIS OR NON-ANION GAP METABOLIC ACIDOSIS AIDS IN THE DETERMINATION OF THE ETIOLOGY AND HENCE APPROPRIATE TREATMENT. FIRST, TO DETERMINE WHETHER THERE IS A HIGH ANION GAP, THE ANION GAP MUST BE CALCULATED. HOWEVER, IN PATIENTS WITH ABNORMAL LEVELS OF ALBUMIN THIS MUST BE CORRECTED. IF THE CORRECTED ANION GAP IS GREATER THAN 12, THIS SUGGESTS AN INCREASED PRESENCE OF UNMEASURED ANIONS. SUBSEQUENTLY, THE OSMOLAR GAP SHOULD BE CALCULATED TO SCREEN FOR THE PRESENCE OF ALCOHOLS, AND ETHANOL, ACETAMINOPHEN, LACTATE, SALICYLIC ACID, CREATININE, AND KETONES SHOULD BE MEASURED. ADDITIONAL TESTING INCLUDES ARTERIAL OR VENOUS BLOOD GAS, URINALYSIS, COMPLETE BLOOD COUNT, AND EVALUATION OF CONCOMITANT RESPIRATORY OR METABOLIC DISTURBANCES. CALCULATING THE DELTA/DELTA RATIO OF ANION GAP AND BICARBONATE CAN AID IN THIS. CHECKING FOR D-LACTATE WOULD BE APPROPRIATE IN A PATIENT WITH SHORT GUT SYNDROME (POST GASTRIC-BYPASS SURGERY), AS DELIVERY OF A LARGE AMOUNT OF CARBOHYDRATE TO THE COLON COULD PROMOTE BACTERIAL SECRETION OF SAID CHEMICAL NOT TYPICALLY TESTED FOR. EKG COULD DETECT CHANGES CAUSED BY ABNORMAL ELECTROLYTES, AND ABDOMINAL RADIOGRAPHY COULD BE EMPLOYED TO EVALUATE FOR RENAL STONES OR IRON INGESTION. THIS ACTIVITY DESCRIBES THE PATHOPHYSIOLOGY, EVALUATION, AND MANAGEMENT OF HIGH ANION GAP METABOLIC ACIDOSIS AND HIGHLIGHTS THE ROLE OF THE INTERPROFESSIONAL TEAM IN ENHANCING CARE DELIVERY FOR AFFECTED PATIENTS.