🧪 NCLEX Metabolic Acidosis: AG, HAGMA & NAGMA Made Easy

Metabolic acidosis is a high-yield acid-base disorder that often shows up in NCLEX case studies involving renal failure, DKA, diarrhea, or shock. What makes this topic especially testable is understanding how to differentiate between anion gap types:

• AG (Anion Gap)

• HAGMA (High Anion Gap Metabolic Acidosis)

• NAGMA (Normal Anion Gap Metabolic Acidosis)

Today’s blog breaks it all down visually and mnemonically so you can answer ABG and electrolyte questions with confidence.

🧪 What Is the Anion Gap?

The Anion Gap (AG) helps identify the cause of metabolic acidosis by measuring unmeasured anions in the blood. The calculation is:

AG = Na⁺ – (Cl⁻ + HCO₃⁻)

• Normal Range: 8–12 mEq/L

• A high AG indicates that extra acids (like ketones or lactate) are present

📊 AG Types of Metabolic Acidosis

Type	AG Level	Cause	NCLEX Examples
AG	8–12	Normal	Diarrhea, renal tubular acidosis
HAGMA	> 12	Excess acids (unmeasured)	DKA, lactic acidosis, uremia
NAGMA	Normal	Loss of bicarbonate replaced by Cl⁻	Diarrhea, saline overload, ileostomy

🧠 Mnemonics to Memorize

HAGMA Causes – "MUDPILES"

• Methanol

• Uremia

• DKA

• Paraldehyde

• Isoniazid/Iron

• Lactic acidosis

• Ethylene glycol

• Salicylates

NAGMA Causes – "HARDASS"

• Hyperalimentation

• Acetazolamide

• Renal tubular acidosis

• Diarrhea

• Aldosterone deficiency

• Spironolactone

• Saline infusion

📝 NCLEX Practice Question

Q: A client with suspected DKA has a Na⁺ of 138, Cl⁻ of 102, and HCO₃⁻ of 14. What is the anion gap?

• A. 20 ✅

• B. 10

• C. 12

• D. 8

Rationale: 138 – (102 + 14) = 22 → HAGMA (DKA).

📌 Summary Tips

• Use AG to interpret all cases of metabolic acidosis

• HAGMA = excess acids (MUDPILES)

• NAGMA = bicarbonate loss or Cl⁻ retention

• Be able to calculate AG and interpret the pattern

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