Causes of Metabolic Acidosis
Cause | Examples |
|---|---|
High anion gap | |
Ketoacidosis | Alcohol (chronic abuse) Fasting |
Lactic acidosis (due to physiologic processes) | Alcohol (chronic abuse) Primary hypoxia due to lung disorders |
Lactic acidosis (due to exogenous toxins) | Biguanides (rare except with acute kidney injury) Carbon monoxide Cyanide HIV nucleoside reverse transcriptase inhibitors Iron Toluene (initially high gap; subsequent excretion of metabolites normalizes gap) |
D-Lactate generation | |
— | |
— | |
Toxins metabolized to acids | Ethylene glycol (oxalate) Methanol (formate) Paraldehyde (acetate, chloracetate) Salicylates |
Normal anion gap (hyperchloremic acidosis) | |
Gastrointestinal bicarbonate (HCO3−) loss | 2) Colostomy Diarrhea Enteric fistulas Ileostomy Magnesium sulfate (MgSO4) Use of ion-exchange resins |
Parenteral infusion | Arginine Ammonium chloride (NH4Cl) Lysine |
Renal HCO3− loss | Hyperparathyroidism Renal tubular acidosis, types 1, 2, and 4 Tubulointerstitial renal disease |
Urologic procedures | Ureteroileal conduit Ureterosigmoidostomy |
Other | Hypoaldosteronism Toluene (late) |