‘MUD PILES’ then and now: Metabolic acidosis with elevated anion gap
| Then | Now |
|---|---|
| Methanol | Methanol |
| Uremia | Uremia |
| Diabetic ketoacidosisa | Diabetic ketoacidosis |
| Paraldehyde | Pyroglutamate and propylene glycolc |
| Isoniazid | Isoniazid and ingestions |
| Lactic acidemia (L and D)b | Lactic acidemiad |
| Ethylene glycol | (di)Ethylene glycol |
| Salicylates | Salicylates |
↵a Ketoacidosis can be a complication of alcoholism (betahydroxybutyric acid).
↵b d-Lactate is a consequence of short-bowel syndrome. If more common causes of metabolic acidosis are not present and the patient has a history suggesting short-bowel syndrome, d-lactate can be considered.
↵c If the patient is older, female, and has a history of acetaminophen ingestion—and if more common causes of metabolic acidosis are not present—consider pyroglutamic acid metabolic acidosis as an etiology.
↵d d-Lactate can also be a consequence of propylene glycol metabolic acidosis.