Causes of Anion Gap Metabolic Acidosis (AGMA)
I notice there may be confusion in your question - you asked about "AGMA" which typically refers to Anion Gap Metabolic Acidosis in medical practice, not "Acute Generalized Myasthenia Attack." The evidence provided discusses myasthenia gravis extensively, but I'll address the standard medical interpretation of AGMA.
Classic Causes of Anion Gap Metabolic Acidosis
The primary causes of anion gap metabolic acidosis are best remembered by the mnemonic MUDPILES or GOLDMARK:
High-Yield Causes:
- Methanol ingestion - causes severe metabolic acidosis with visual disturbances and can be fatal
- Uremia - from advanced renal failure with accumulation of organic acids
- Diabetic ketoacidosis (DKA) - from accumulation of β-hydroxybutyrate and acetoacetate
- Propylene glycol - often from IV medications (lorazepam, diazepam, phenobarbital)
- Isoniazid/Iron overdose - INH causes seizures and lactic acidosis; iron causes direct toxicity
- Lactic acidosis - Type A (tissue hypoperfusion from shock, sepsis, cardiac arrest) or Type B (medications like metformin, malignancy, liver failure)
- Ethylene glycol - antifreeze ingestion causing oxalate crystal deposition and renal failure
- Salicylates - aspirin overdose causing mixed respiratory alkalosis and metabolic acidosis
Additional Important Causes:
- D-lactic acidosis - from short bowel syndrome with bacterial overgrowth
- Alcoholic ketoacidosis - in chronic alcohol users with recent binge and poor oral intake
- Starvation ketoacidosis - prolonged fasting leading to ketone body production
- Toluene - from inhalant abuse, though may present with normal anion gap after metabolism
- Rhabdomyolysis - severe muscle breakdown releasing organic acids
Clinical Approach:
Calculate the anion gap: Na - (Cl + HCO3), with normal being 8-12 mEq/L
Assess for elevated osmolar gap (>10 mOsm/kg) suggesting toxic alcohol ingestion (methanol, ethylene glycol, propylene glycol)
Check serum lactate immediately - most common cause of AGMA in hospitalized patients
Obtain urinalysis - calcium oxalate crystals suggest ethylene glycol; ketones suggest DKA or alcoholic ketoacidosis
Review medication list - metformin (lactic acidosis), propofol (propofol infusion syndrome), linezolid, nucleoside reverse transcriptase inhibitors
If you intended to ask about triggers for myasthenic crisis in patients with myasthenia gravis, please clarify and I can provide that information based on the evidence provided.