So welcome back to the Internet Book of Critical Care Podcast.

I'm here with Adam Thomas and we're back at you with non-an-gat metabolic acidosis or

nagma.

We hit you with the agma.

Here's the nagma.

We're giving you all the acronyms.

Just to remind you, I know you guys are on this, but if you go back to the basics

when we cover the approach to metabolic disturbances, we're going to start with the anion

gap, sodium minus bicarb minus chloride.

In this one, it's less than 12.

It's the non-anine gap, metabolic acidosis.

So Josh, walk me through this part of our algorithm.

Just to be irritating, it is also possible to have a combination agma plus anagma diagnosed

by the Delta Delta Delta.

And that's why you need the Delta Delta Delta, you Sid, kids.

That's why you need the Delta Delta Delta.

Yeah, but so once you get to the diagnosis of Nagma one way or the other, the common causes

of this are normal salient infusion, which is poison, as we've discussed earlier, resolving diabetic

ketoacidosis.

So typically folks come in with aniongap, metabolic acidosis, and DCA, and over time

that's going to resolve.

But then if they're resuscitated with normal saline or if they excrete a lot of keto acid

...