Which of the following condition is not associated with an increased anion-gap type of metabolic acidosis?
Correct Answer: COPD
Description: High-anion gap metabolic acidosis is caused by ? Lactic acidosis ? Ketoacidosis (Diabetic, Alcoholic, Starvation) ? Toxins - Ethylene glycol, Methanol, Salicylates, Propylene glycol and Pyroglutamic acid and ? Renal failure (acute and chronic). COPD is not associated with high anion gap metabolic acidosis. Metabolic acidosis results from an imbalance between the plasma concentration of H+ and HCO3- and is defined as a decrease in to below 22meq/l with a decrease in pH below 7.36. High anion gap metabolic acidosis result from excess accumulation of fixed acid. If its level is increased to 30mmol/L or more, a high anion gap metabolic acidosis is present regardless of pH and HCO3. Anion gap is calculated by the formula, anion gap= Na+ - (CL- + HCO-3). Normal value is 8- 12 mmol/l. Ref: Harrison's Principle of Internal Medicine, 18th Edition, Page 366, Table 47-4; CURRENT Diagnosis and Treatment Emergency Medicine, 7th Edition, Chapter 44
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