Differential Diagnosis for High Anion Gap Metabolic Acidosis of Unknown Etiology
Single Most Likely Diagnosis
- Diabetic Ketoacidosis (DKA): This condition is a common cause of high anion gap metabolic acidosis, particularly in patients with diabetes. It occurs due to a deficiency in insulin, leading to the production of ketone bodies, which are acidic and contribute to the high anion gap.
Other Likely Diagnoses
- Lactic Acidosis: This can occur due to tissue hypoxia, sepsis, or as a side effect of certain medications like metformin. Lactic acidosis is a significant cause of high anion gap metabolic acidosis.
- Alcoholic Ketoacidosis: Similar to DKA, but occurs in the context of alcohol abuse. It is caused by the depletion of glycogen stores and the production of ketone bodies.
- Salicylate Toxicity: Aspirin overdose can lead to high anion gap metabolic acidosis due to the accumulation of salicylate, which is an unmeasured anion.
Do Not Miss Diagnoses
- Methanol or Ethylene Glycol Poisoning: Although less common, these conditions can be fatal if not promptly diagnosed and treated. They cause high anion gap metabolic acidosis due to the accumulation of toxic metabolites.
- Uremia: In the context of renal failure, the accumulation of sulfates, phosphates, and other organic anions can lead to high anion gap metabolic acidosis.
Rare Diagnoses
- Ketone Body Production in Starvation: Prolonged fasting or starvation can lead to the production of ketone bodies, resulting in high anion gap metabolic acidosis.
- Isovaleric Acidemia and Other Organic Acidemias: These are rare genetic disorders that affect the metabolism of amino acids and can lead to the accumulation of organic acids, causing high anion gap metabolic acidosis.
- Pyroglutamic Acidemia (5-Oxoprolinemia): A rare condition caused by an inborn error of glutathione metabolism, leading to the accumulation of 5-oxoproline, an unmeasured anion.