High anion gap metabolic acidosis (HAGMA) may be caused by a number of conditions. Several mnemonics have been proposed to recall these conditions, including GOLD MARK and KUSMALE.
GOLD MARK
ethylene or propylene glycol
G
oxyproline (pyroglutaminc acid)
O
L-lactate
L
D-lactate
D
methanol
M
aspirin, salicylate
A
renal failure (uremia)
R
ketoacidosis
K
paraldehyde, phenformin
isoniazid, iron
alcoholic ketoacidosis
K
where:
• Lactic acid includes carbon monoxide and cyanide poisoning.
KUSMALE
ethylene or propylene glycol
E
oxyproline (pyroglutaminc acid)
L-lactate
L
D-lactate
L
methanol
M
aspirin, salicylate
S
renal failure (uremia)
U
ketoacidosis
K
paraldehyde, phenformin
A
isoniazid, iron
alcoholic ketoacidosis
K
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