nonanion gap metabolic acidosis NAGMA

This patient presents with non-anion gap metabolic acidosis, which can be caused by numerous agents.  Carbonic anhydrase inhibitors, including acetazolamide (used for glaucoma) and topiramate (used for seizures and migraine headaches), typically cause bicarbonate diuresis with resultant non-anion gap metabolic acidosis.  Many of the other implicated agents cause mild forms of renal tubular acidosis with accompanying non-anion gap metabolic acidosis, sometimes due to interstitial nephritis.

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