What is the primary treatment approach for someone with an increased anion gap?

The primary treatment approach for someone with an increased anion gap is to treat the underlying cause of the metabolic acidosis. An increased anion gap often indicates the presence of unmeasured anions, which can be due to conditions such as diabetic ketoacidosis, lactic acidosis, renal failure, or intoxication (e.g., with methanol or salicylates).

By identifying and addressing the specific cause of the elevated anion gap, clinicians can effectively restore acid-base balance and improve the patient's overall clinical condition. For instance, in cases of diabetic ketoacidosis, insulin and fluid replacement will correct the acidosis, while in lactic acidosis, addressing the underlying hypoxia or reducing substrate accumulation may be necessary.

This approach is more beneficial than immediate interventions like dialysis or diuretics, which may be required later depending on the severity and specific underlying condition, but do not directly solve the issue of the increased anion gap itself. Administering potassium supplements can also be inappropriate or even harmful, as metabolic acidosis can cause shifts in potassium that require careful monitoring and management. Thus, targeting the underlying cause is the most effective and appropriate initial strategy.