Clueless In Colorado

May 9th, 2007


Dear Paw Paw:


The other night I saw a diabetic dialysis patient who had drunk a lot of hooch and popped some kind of pills to try to get high. My professional diagnosis was that he was Really Sick. I called the Hospitalist who asked me for his anion gap. I didn’t know what he was talking about and he got frustrated with me. He said something to me about mudpiles, but I don’t know how playing in the dirt has anything to do with taking care of patients. Should I complain about him?

Dr. Clueless in Coloarado

Dear Dr. Clueless:


Oh this goes way off the scale on my Stupid O Meter. He should complain about you! Anion Gap is not where the pioneers crossed over the Appalachian Mts. on their journey to the West. It is a way to characterize patients with metabolic acidosis and help identify the causes. Metabolic acidosis can be associated with low, normal or elevated Anion Gap. Mudpiles is a mnemonic for the causes of elevated anion gap acidosis:


M Methanol
U Uremia
D DKA, AKA or starvation ketosis
P Paraldehyde, Phenformin (Metformin)
I Iron, INH
L Lactic Acidosis
E Ethylene glycol
S Salicylates

The anion gap can be calculated by the formula: Na – (Cl + CO2). Normally, it is less than or equal to 12. If it is more than 12 it is elevated. Low anion gap acidosis is really weird and we won’t go into that now. Normal Anion Gap acidosis has the mnemonic “HARD UP” which you obviously are. Hard Up stands for:

H Hypoaldosteronism
A Acetazolamide
R Renal Tubular Acidosis
D Diarrhea
U Uretero-sigmoidostomy
P Pancreatic fistula

Now go and read about Acid – Base Disorders and try to be a real doctor.
Paw Paw