GOLD MARK Mnemonic
The GOLD MARK mnemonic stands for the causes of high anion gap metabolic acidosis: Glycols (ethylene and propylene), Oxoproline, L-lactate, D-lactate, Methanol, Aspirin, Renal failure, and Ketoacidosis. 1
Components of the Mnemonic
The GOLD MARK mnemonic provides a systematic approach to evaluating patients with unexplained anion gap metabolic acidosis, serving as a more comprehensive alternative to the classic MUDPILES mnemonic 1:
- G - Glycols: Includes both ethylene glycol and propylene glycol toxicity 1
- O - Oxoproline: Also known as pyroglutamic acid, can accumulate in certain conditions 1
- L - L-lactate: The typical lactic acid seen in tissue hypoxia and shock 1
- D - D-lactate: Produced by bacterial fermentation in short bowel syndrome or other gastrointestinal conditions 1
- M - Methanol: Toxic alcohol ingestion 1
- A - Aspirin: Salicylate toxicity 1
- R - Renal failure: Uremia causing accumulation of organic acids 1
- K - Ketoacidosis: Including diabetic, alcoholic, and starvation ketoacidosis 1
Clinical Application
This mnemonic serves as a memory tool to systematically work through potential causes when evaluating a patient with high anion gap metabolic acidosis 1. Mnemonics function effectively because they link new information to well-known patterns and provide alternative routes to remembering compared to traditional learning methods 2.
Important Caveat
When using laboratory assays to evaluate these causes, be aware that certain substances can cause analytical interference. For example, benzoic acid (used as a dietary supplement) can interfere with salicylate assays, potentially leading to false-positive results even when aspirin has not been administered 1. This highlights the importance of correlating laboratory findings with clinical history and considering alternative explanations when results don't match the clinical picture 1.