Reply To: VNCert EEC Exam Question: Blood Gas

Annette challenge is always good 🙂

Here’s another pneumonic I’ve come across recently in the human literature plus seen it on VIN

MUD PILERS

Increased AG: metabolic AG acidosis (methanol, uraemia, diabetes/diabetic ketoacidosis (DKA), paraldehyde, isopropyl alcohol, lactate, ethylene glycol, rhabdomyolysis, salicilate (aspirin) MUD PILERS).

All of these can cause an increased AG as they’re increases in unmeasured anions.

A metabolic acidosis due to bicarbonate loss e.g. diarrhoea usually results in a normal AG

We can’t differentiate between these groups without an AG.

In this question we’re assuming it’s the hyperlacteraemia causing the acidosis which is fair but vomiting is so non-specific without hx I was thinking to be aware of a DKA/ureamic patient too.

Re lactate and hypovol. I agree we don’t know the cause of the hyperlacteraimia until fluid resuscitation is complete. I guess what I was disagreeing with is the concept of high lactate is lactic acidosis or poor tissue perfusion. Poor tissue perfusion is a cause of lactic acidosis.

S