Metabolic Acidosis-Elevated Anion Gap (Anion Gap Metabolic Acidosis, AGMA)





  • Diethylene Glycol Intoxication (see Diethylene Glycol, [[Diethylene Glycol]])
  • Ethylene Glycol Intoxication (see Ethylene Glycol, [[Ethylene Glycol]])
  • Formaldehyde Intoxication (see Formaldehyde, [[Formaldehyde]])
  • Methanol Intoxication (see Methanol, [[Methanol]])
  • Paraladehyde Intoxication (see Paraldehyde, [[Paraldehyde]])
  • Propylene Glycol Intoxication (see Propylene Glycol, [[Propylene Glycol]])
  • Pyroglutamic Acidosis (PCA, Pidolic Acid, Pyroglutamate, 5-Oxoproline) (see Pyroglutamic Acidosis, [[Pyroglutamic Acidosis]])
  • Salicylate Intoxication (see Salicylates, [[Salicylates]])
  • Toluene Intoxication (see Toluene, [[Toluene]])


Etiology (GOLDMARK Mnemonic)


Serum Chemistry

  • Serum Bicarbonate: decreased
  • Anion Gap (see Serum Anion Gap, [[Serum Anion Gap]]): elevated

Arterial Blood Gas (ABG) (see Arterial Blood Gas, [[Arterial Blood Gas]])

  • Decreased Serum Bicarbonate with Respiratory Compensation: assessment of the appropriateness of respiratory compensation can be determined using standard rules of expected compensation (see Acid-Base, [[Acid-Base]])

Serum Osmolality (see Serum Osmolality, [[Serum Osmolality]])

  • Osmolal Gap: variable (depending on the etiology)

Clinical Manifestations

Renal Manifestations

  • Anion Gap Metabolic Acidosis (AGMA)


  • Treat Underlying Disorder


  • Systematic review of current guidelines, and their evidence base, on risk of lactic acidosis after administration of contrast medium for patients receiving metformin. Radiology Jan 2010; 254:261-269
  • Diagnostic Challenge in a Patient with Severe Anion Gap Metabolic Acidosis. Case Rep Crit Care. 2015;2015:272914. doi: 10.1155/2015/272914. Epub 2015 May 31 [MEDLINE]