Which condition can cause an increase in anion gap metabolic acidosis?

Anion gap metabolic acidosis occurs when there is an accumulation of acids in the body, leading to an increased gap between measured cations and anions in the serum. An increased anion gap indicates the presence of unmeasured anions, typically as a result of conditions that contribute excess acids.

Diabetes mellitus can lead to diabetic ketoacidosis (DKA), which is characterized by the production of ketone bodies, thus causing an increase in the anion gap. The presence of these ketoacids shifts the balance of serum electrolytes, resulting in a higher anion gap.

Aspirin overdose, known as salicylate toxicity, can lead to metabolic acidosis through the accumulation of organic acids. Salicylates stimulate anaerobic metabolism, leading to lactic acidosis, and they also increase ketogenesis, both of which contribute to an elevated anion gap.

Chronic kidney disease (CKD) ultimately leads to the accumulation of metabolic acids due to decreased renal function, reducing the kidneys' ability to excrete acids and thereby causing a buildup of such acids in the serum, which increases the anion gap.

Since each of these conditions independently can cause an increase in the anion gap, the correct choice encompasses all three