4.11 SFGH AM Report Pearls – GOLDMARK versus MUDPILES

In report, we touched on the famous mnemonics to remember the etiologies of anion gap metabolic acidosis. We discussed the use of a new mnemonic, GOLDMARK, to replace MUDPILES. Read on for more…


G = glycols (ethylene and propylene)

O = oxoproline (alias = pyroglutamic acid; elevated levels occur with chronic acetaminophen use)

L = L-lactate

D = D-lactate (present in patients with short bowel syndromes)

M = methanol

A = aspirin

R = renal failure –> uremia

K = ketoacidosis

Some might argue: “But, I love MUDPILES! Why the new mnemonic?!?” Here is the reasoning:

MUDPILES (methanol, uremia, DKA, paraldehyde, isoniazid/iron, lactate, ethylene glycol, salicylate) is often referenced when discussing the differential for anion gap metabolic acidosis. The argument for switching from MUDPILES to GOLDMARK was the following:

  • Paraldehyde use is very very rare
  • Iron and isoniazid are just two of many drugs that lead to lactic acidosis and thus would be accounted for in the “L” in GOLDMARK
  • Three new acids and acid precursors that can lead to an anion gap acidosis have been recognized as causing anion gap metabolic acidosis: 1) D-lactate, 2) 5-oxoproline, 3) propylene glycol

The attached Lancet article is where it is first introduced.

Will you be an adopter???


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