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Singh, S., et al., Recurrent Metabolic Acidosis during High-dose Midazolam Therapy for Refractory Status Epilepticus. Indian J Crit Care Med, 2018. 22(2): p. 119-121.

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Recurrent Anion Gap Metabolic Acidosis

1State University of New York, Downstate Medical Center, Department of Internal Medicine, Brooklyn, NY 11203 USA

American Journal of Medical Case Reports. 2019, Vol. 7 No. 9, 200-202
DOI: 10.12691/ajmcr-7-9-5
Copyright © 2019 Science and Education Publishing

Cite this paper:
Abin Sajan, Judah Horowitz, Noriyuki Murakami, Isabel M. McFarlane. Recurrent Anion Gap Metabolic Acidosis. American Journal of Medical Case Reports. 2019; 7(9):200-202. doi: 10.12691/ajmcr-7-9-5.

Correspondence to: Isabel  M. McFarlane, State University of New York, Downstate Medical Center, Department of Internal Medicine, Brooklyn, NY 11203 USA. Email:


Background: Metabolic acidosis refers to any process that increases the hydrogen ions in the body and reduces the bicarbonate concentration. Metabolic acidosis is subdivided based on presence of anion gap (AG), and AG metabolic acidosis is most often due to ketoacidosis, lactic acidosis, renal failure, or toxic ingestions. AG metabolic acidosis is frequently encountered in the clinical practice. Rarely, the underlying cause of the AG metabolic acidosis is considered a diagnostic dilemma as the established algorithm allows the physicians to identify the etiology. Case presentation: A fifty-three-year-old Black woman with well-controlled human immunodeficiency virus (HIV), hypertension, and asthma presented with recurrent episodes of severe anion gap metabolic acidosis. The patient’s AG metabolic acidosis always corrected with the administration of intravenous normal saline. Laboratory studies were always negative for common causes of acidosis. Conclusion: Nucleoside reverse transcriptase inhibitors-associated lactic acidosis has been reported in the literature. The shift to anaerobic mitochondrial metabolism induced by the HIV medications used in this patient could be explain the recurrent severe metabolic acidosis.