Discussion Metabolic acidosis with an elevated anion gap has a limited differential diagnosis (Box 1). 1, 4 – 6 The laboratory tests investigating these typical causes were negative in our patient.

Hyperchloremic, Normal Anion-Gap, Metabolic Acidosis Due to Topiramate Kathryn D. Mathews, PharmD; Jennifer E. Stark, PharmD, BCPS Disclosures Am J Health Syst Pharm. 2008;65 (15):1430-1434.

3. There are 3 types of renal tubular acidosis (RTA). A positive urine anion gap is suggestive of RTA as the cause of nongap metabolic acidosis, as opposed to diarrhea or normal saline.

Metabolic cardiomyopathies are an important consideration when evaluating young patients with unexplained ventricular dysfunction (Box 1). 4 They should be suspected when cardiomyopathy is accompanied ...

The pathogenesis of metabolic acidosis in this setting is driven by the accumulation of these organic acids, overwhelming normal buffering capacities.