As we are now into the winter months, exposures to ethylene glycol (antifreeze) and methanol (windshield washer fluid) increase. Here is a good mnemonic for sorting through an anion gap metabolic acidosis:
C – cyanide, carbon monoxide A – alcoholic ketoacidosis, acetaminophen (massive OD) T – toluene (chronic from glue sniffing) M – methanol, metformin U – uremia D – diabetic ketoacidosis P – propofol infusion syndrome, propylene glycol, paraldehyde I – iron, isoniazid, ibuprofen (massive OD) L – lactic acidosis E – ethylene glycol S – salicylates, starvation ketoacidosis
