High anion gap acidosis is seen in all except:
Correct Answer: Diarrhea
Description: Ref: Nelson's Textbook of Pediatrics, I9rb edition, Page 231Explanation:PLASMA ANION GAPDifference between the measured cation (sodium) and the measured anions (chloride + bicarbonate).Also the difference between the unmeasured cations (potassium, magnesium, calcium) and the unmeasured anions (albumin, phosphate, urate, sulfate).Used to evaluate and categorise patients with a metabolic acidosis.Metabolic acidosis is divided into subcategories:o Increased anion gap acidosis.o Normal anion gap acidosis.Normal anion gap is 4-11.Formula: Anion Gap = - - .Increased anion gap metabolic acidosis occurs when there is an increase in unmeasured anions.Normal anion gap metabolic acidosis occurs when there is a decrease in the bicarbonate concentration without an increase in the unmeasured anions.Approximately 11 mEq of the anion gap is normally secondary to albumin.A 1-g/dL decrease in the albumin concentration decreases the anion gap by roughly 2.5 mEq/ L. Increase in unmeasured cations, such as calcium, potassium and magnesium, decreases the anion gap.CAUSES OF METABOLIC ACIDOSISNormal Anion GapDiarrhea.Renal tubular acidosis (Distal, Proximal and Hyperkalemic types).Urinary tract diversions.Post-hypocapnia.Ammonium chloride intake.Increased Anion GapLactic acidosis:Tissue hypoxia: Shock. Hypoxemia. Severe anemia.Liver failure.Malignancy.Intestinal bacterial overgrowth.Inborn errors of metabolism.Medications: Nucleoside reverse transcriptase inhibitors. Metformin. Propofol.Ketoacidosis:Diabetic ketoacidosis.Starvation ketoacidosis.Alcoholic ketoacidosis.Kidney failure.Poisoning:Ethyleneglycol.Methanol.Salicylate.Toluene.Paraldehyde.Inborn errors of metabolism.
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