Causes of Metabolic Acidosis with Elevated Anion Gap - Differential Diagnosis Algorithm

Elevated Anion Gap > 12 (Gain of H+) - Need to correct anion gap for albumin: For every drop of 10 for albumin (from 40) add 2.5 to the anion gap

Decreased NH4 production and anion secretion

 • AKI/CKD

Salicylate poisoning

Lactic acidosis

 • Shock

 • Drugs

 • Inborn errors

Ketosis

 • Diabetic ketoacidosis

 • Starvation/alcoholic Ketosis

Toxic alcohol ingestion

 • Ethylene/Propylene glycol

 • Methanol

Other ingestion

 • Paraldehyde, Iron, Isoniazid, Toluene, Cyanide



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