MUDPILES
acrostic/ˈmʌd.paɪlz/
Nephrology
Definition
1.The causes of a high anion gap metabolic acidosis.
Expansion
- MMethanol — also produces a visual disturbance
- UUraemia — renal failure, retained organic acids
- DDiabetic ketoacidosis — and other ketoacidoses (alcoholic, starvation)
- PParaldehyde / Propylene glycol — the latter a solvent in some IV drugs
- IIron / Isoniazid — toxic ingestions
- LLactic acidosis — sepsis, ischaemia, metformin
- EEthylene glycol — antifreeze; causes oxalate crystals
- SSalicylates — aspirin overdose (mixed picture)
Notes
When you find a metabolic acidosis, the first fork in the road is the anion gap (Na⁺ − [Cl⁻ + HCO₃⁻]). A raised gap means unmeasured acids are present — and MUDPILES is the list of suspects.
A normal gap acidosis is a different beast (think diarrhoea or renal tubular acidosis), so anchor on the gap first, then reach for this mnemonic.
Origin
Eight ways to fill the blood with unmeasured acid — a heap of trouble.