MUDPILES Mnemonic

High Anion Gap Metabolic Acidosis
Anion gap = Na – (Cl + HCO₃)
Normal AG = 8–12 (up to 16 with albumin correction)

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M – Methanol

• Causes: formaldehyde & formic acid buildup

• Clues: visual changes (“snowfield vision”), CNS depression

U – Uremia

• Renal failure → cannot excrete acid

• Clues: high BUN/Cr, pericarditis, edema

D – DKA (Diabetic ketoacidosis)

Also includes:

• Alcoholic ketoacidosis (AKA)

• Starvation ketoacidosis

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P – Propylene Glycol

• Found in IV lorazepam/phenobarbital formulations

• Can cause lactic acidosis

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I – Iron or Isoniazid (INH)

• Iron overdose → shock, acidosis

• INH → seizures + lactic acidosis

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L – Lactic Acidosis

Most common in ICU:

• Sepsis

• Shock (hypoperfusion)

• Seizures

• Metformin toxicity (rare)

• Liver failure

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E – Ethylene Glycol

• Antifreeze ingestion

• Toxic metabolites: oxalic acid

• Clues: calcium oxalate crystals, hypocalcemia, renal failure

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S – Salicylates (Aspirin overdose)

• Causes mixed disorder:

  • Early respiratory alkalosis

  • Later high–anion gap metabolic acidosis

• Clues: tinnitus, hyperventilation

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Modern alternative mnemonic (updated ICU version):

“GOLDMARK”

Often used instead of MUDPILES:

Glycols
Oxoproline (chronic acetaminophen)
L-lactate
D-lactate
Methanol
Aspirin
Renal failure
Ketoacidosis