Case Series

Volume: 8 | Issue: 8 | Published: Aug 26, 2024 | Pages: 161 - 168 | DOI: 10.24911/ejmcr.173-1714213495

Approach to poisoned patients with high anion gap metabolic acidosis in the emergency department - a case series


Authors: Reem Khalid Ali , Ebtesam Safi , Tibah Ahmad Al Abbasi , Salma AlRajaby


Article Info

Authors

Reem Khalid Ali

Dubai Health, Emergency Department, United Arab Emirates

Ebtesam Safi

Dubai Health, Emergency Department, United Arab Emirates

Tibah Ahmad Al Abbasi

Dubai Health, Emergency Department, United Arab Emirates

Salma AlRajaby

Dubai Health, Emergency Department, United Arab Emirates.

Publication History

Received: April 27, 2024

Revised: June 12, 2024

Accepted: June 15, 2024

Published: August 26, 2024


Abstract


Toxicology cases are frequent presentations in the emergency department (ED) and often their presentation can vary from a straightforward manner to a complex manner. In this case series we will discuss three cases that presented to the ED with a known, suspected, and unknown toxicological substance ingestion with the common denominator being high anion gap metabolic acidosis (HAGMA). HAGMA is a subcategory of metabolic acidosis. Categorizing metabolic acidosis as a high anion gap aids in identifying the underlying disease process and subsequently initiating appropriate treatment. There have been many broadly inclusive mnemonics used to list the common causes of High anion gap acidosis such as CAT MUDPILES which correspond to Carbon monoxide, Cyanide, Congenital heart disease, Aminoglycosides, Theophylline, Toluene, Methanol, Uremia, Diabetic ketoacidosis, Alcoholic ketoacidosis, Starvation, Acetaminophen, Phenformin, Paraldehyde, Iron, Isoniazid, Inborn errors of metabolism, Lactic acidosis, Ethanol, Ethylene glycol, and Salicylates, respectively. It is not uncommon to be faced with patients with an unclear clinical picture and a lack of clear toxicological ingestion. In such circumstances, the presence of a high anion gap acidosis is an important clue that should prompt investigating for uncommon toxicological causes not listed in the forementioned mnemonics, such as metformin, beta blockers, and CCBs.

Keywords: Metformin, calcium channel blocker (CCB), methanol, high anion gap metabolic acidosis (HAGMA), toxicology, poisoning, green


Pubmed Style

Reem Khalid Ali, Ebtesam Safi, Tibah Ahmad Al Abbasi, Salma AlRajaby. Approach to poisoned patients with high anion gap metabolic acidosis in the emergency department - a case series. EJMCR. 2024; 26 (August 2024): 161-168. doi:10.24911/ejmcr.173-1714213495

Web Style

Reem Khalid Ali, Ebtesam Safi, Tibah Ahmad Al Abbasi, Salma AlRajaby. Approach to poisoned patients with high anion gap metabolic acidosis in the emergency department - a case series. https://ejmcr.com/articles/1229 [Access: December 25, 2024]. doi:10.24911/ejmcr.173-1714213495

AMA (American Medical Association) Style

Reem Khalid Ali, Ebtesam Safi, Tibah Ahmad Al Abbasi, Salma AlRajaby. Approach to poisoned patients with high anion gap metabolic acidosis in the emergency department - a case series. EJMCR. 2024; 26 (August 2024): 161-168. doi:10.24911/ejmcr.173-1714213495

Vancouver/ICMJE Style

Reem Khalid Ali, Ebtesam Safi, Tibah Ahmad Al Abbasi, Salma AlRajaby. Approach to poisoned patients with high anion gap metabolic acidosis in the emergency department - a case series. EJMCR. (2024), [cited December 25, 2024]; 26 (August 2024): 161-168. doi:10.24911/ejmcr.173-1714213495

Harvard Style

Reem Khalid Ali, Ebtesam Safi, Tibah Ahmad Al Abbasi, Salma AlRajaby (2024) Approach to poisoned patients with high anion gap metabolic acidosis in the emergency department - a case series. EJMCR, 26 (August 2024): 161-168. doi:10.24911/ejmcr.173-1714213495

Chicago Style

Reem Khalid Ali, Ebtesam Safi, Tibah Ahmad Al Abbasi, Salma AlRajaby. "Approach to poisoned patients with high anion gap metabolic acidosis in the emergency department - a case series." 26 (2024), 161-168. doi:10.24911/ejmcr.173-1714213495

MLA (The Modern Language Association) Style

Reem Khalid Ali, Ebtesam Safi, Tibah Ahmad Al Abbasi, Salma AlRajaby. "Approach to poisoned patients with high anion gap metabolic acidosis in the emergency department - a case series." 26.August 2024 (2024), 161-168. Print. doi:10.24911/ejmcr.173-1714213495

APA (American Psychological Association) Style

Reem Khalid Ali, Ebtesam Safi, Tibah Ahmad Al Abbasi, Salma AlRajaby (2024) Approach to poisoned patients with high anion gap metabolic acidosis in the emergency department - a case series. , 26 (August 2024), 161-168. doi:10.24911/ejmcr.173-1714213495