I am a 31-year old female, 130 lbs, and healthy


Q: I am a 31-year old female, 130 lbs, and healthy as far as I know. I don't smoke and rarely drink alcohol, although I do drink a lot of soda.

I had blood drawn two weeks ago and just received the results. I have an appointment with my doctor for follow-up but am very worried because my results show a high anion gap of 23. All my other levels are normal - creatinine, BUN, glucose, sodium, potassium, everything.

I have felt perfectly fine this whole time. Is there any chance this was some sort of error? Could I really have metabolic acidosis when all my other levels are normal? Could any nutritional supplements cause this? I had taken some the day before the blood work but now I don't recall exactly which ones. Thank you.


A:   Welcome to Ask The Doctor.

We are here to help you on this medical health advice platform.
Since you have high anion gap acidosis, we need to evaluate the causes behind that. The common causes of high anion gap acidosis are Methanol, Uremia (kidney problems), Diabetic ketoacidosis, Infection, drugs like Iron, Isoniazid, Lactic acidosis, Salicylates, Ethylene glycol, Propylene glycol. The last two are rare nowadays. You have not mentioned any history of diabetes. In case you have diabetes, you might be having ketoacidosis.
Drinking excessive soda is unlikely to cause this, but we need to know the constituents of the soda.
As far as supplements are concerned, they can cause this problem. As most of the supplements have high level of creatine that can cause acidosis on release. However, since your all other results are normal, your doctor will not give it a much high as this can be an error also. In such scenario, your arterial blood gas analysis would be performed and your drug history would be evaluated. We also check urine for ketones for any evidence of ketoacidosis in such case.
Share my opinion with your doctor. If you have nay further query, please ask me.

I hope it helps.
Stay Healthy

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