<prompt> Which of the following condition is not associated with an increased anion-gap type of metabolic acidosis?Lactic acidosisIngestion of antifreezeDiabetic ketoacidosisCOPD  <response>: High-anion gap metabolic acidosis is caused by ? Lactic acidosis ? Ketoacidosis Diabetic, Alcoholic, Starvation ? Toxins - Ethylene glycol, Methanol, Salicylates, Propylene glycol and Pyroglutamic acid and ? Renal failure acute and chronic. COPD is not associated with high anion gap metabolic acidosis. Metabolic acidosis results from an imbalance between the plasma concentration of H and HCO3- and is defined as a decrease in to below 22meql with a decrease in pH below 7.36. High anion gap metabolic acidosis result from excess accumulation of fixed acid. If its level is increased to 30mmolL or more, a high anion gap metabolic acidosis is present regardless of pH and HCO3. Anion gap is calculated by the formula, anion gap Na - CL- HCO-3. Normal value is 8- 12 mmoll. Ref: Harrisons Principle of Internal Medicine, 18th Edition, Page 366, Table 47-4; CURRENT Diagnosis and Treatment Emergency Medicine, 7th Edition, Chapter 44 