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