nonanion gap metabolic acidosis NAGMA causes
- related: Nephrology, anion gap metabolic acidosis
- tags: #nephrology #literature
The patient has metabolic acidosis with a low serum bicarbonate level and low Paco2. The anion gap is normally between 8 and 12, and this patient has an anion gap of 10. Therefore, she has a normal anion gap metabolic acidosis (or nonanion gap acidosis). This is also called hyperchloremic metabolic acidosis because the serum chloride level is elevated with a low serum bicarbonate level.
The differential diagnosis for a normal anion gap, or hyperchloremic metabolic acidosis, is broad and includes GI losses (from diarrhea, pancreatitis, or intestinal fistulas), intrinsic renal tubular acidoses, and drugs (acetazolamide, angiotension-converting enzyme inhibitors, cyclosporine, trimethoprim, or potassium-sparing diuretics like spironolactone).
USED CARP
- ureterostomy
- small bowel fistula: lose bicarb
- extra chloride
- diarrhea: lose bicarb
- carbonic anhydrase inhibitors: causes bicarb diuresis
- acetazolamide mostly used for glaucoma
- topiramate: used for seizures and migraines
- adrenal insufficiency
- RTA
- pancreatic fistula
- propylene glycol: ativan, diazepam preparations
Other medications can cause NAGAM from interstitial nephritis or RTA:
