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Drug- and toxin-induced alterations in the anion gap

Drug- and toxin-induced alterations in the anion gap
Increased anion gap with metabolic acidosis
(>13 meq/L)*
Methanol
Ethylene glycol
Ethanol (alcoholic ketoacidosis)
Salicylates
Isoniazid
Iron
Glycol ethers
NSAID
Ketoprofen
Naproxen
Phenylbutazone
Sympathomimetics
Cocaine
Theophylline
Caffeine
Cathinones
Albuterol
Increased anion gap with metabolic acidosis
(>13 meq/L) (cont)
Salicylates
Dinitrophenol
Inorganic acid
Metformin
Phenformin
Paraldehyde
Formaldehyde
Toluene
Sulfur (elemental)
Colchicine
Fluroacetate
Cellular asphyxiants
Carbon monoxide
Cyanide
Hydrogen sulfide
Methemoglobinemia
Propylene glycol
Benzyl alcohol
Phenol
Strychnine
Vacor
Decreased anion gap
(<6 meq/L)
Hypermagnesemia
Hypercalcemia
Bromide
Nitrates
Lithium
Iodide
Spironolactone
Ammonium chloride
Acetazolamide
* Any poison causing seizure, hypoxemia, shock (hypotension), cellular anoxia, or rhabdomyolysis will result in a high anion gap metabolic acidosis from increased serum lactic acid concentrations.
Graphic 58822 Version 8.0