Nephrology Book

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Metabolic Acidosis

Aka: Metabolic Acidosis, Non-Anion Gap Metabolic Acidosis, Anion Gap Metabolic Acidosis
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  1. See Also
    1. Arterial Blood Gas
    2. ABG Interpretation
  2. Types
    1. Elevated Anion Gap Metabolic Acidosis
    2. Hyperchloremic Metabolic Acidosis (normal Anion Gap)
      1. See Hyperchloremia
  3. Causes: Elevated Anion Gap (Mnemonic: "MUD PILERS")
    1. Methanol
    2. Uremia
    3. Diabetic Ketoacidosis (DKA) or starvation ketosis
    4. Paraldehyde, Phenformin
    5. Isopropyl Alcohol, Isoniazid
    6. Lactic Acidosis
    7. Ethylene Glycol, Ethyl Alcohol
    8. Rhabdomyolysis
    9. Salicylates
    10. Other Causes: Hyperalbuminemia, administered anions
  4. Causes: Normal Anion Gap (Hyperchloremia)
    1. Hypokalemia with Metabolic Acidosis
      1. Diarrhea
      2. Ureteral diversion
        1. Uretero-sigmoidostomy
        2. Ileal Bladder
        3. Ileal ureter
      3. Renal Tubular Acidosis (proximal or distal)
      4. Mineralocorticoid Deficiency
        1. Angiotensin Deficiency: Liver Failure
        2. ACE Inhibitor
        3. Renin Deficiency
          1. Aging
          2. Extracellular fluid volume expansion
          3. Lead
          4. Beta Blockers
          5. Prostaglandin Inhibitor
          6. Methyldopa
      5. Carbonic anhydrase inhibitor
        1. Acetazolamide
        2. Mefenamic acid
      6. Post-hypocapnia
    2. Hyperkalemia (or normal potassium) Metabolic Acidosis
      1. Renal Failure (Early)
      2. Renal Disease
        1. SLE Interstitial Nephritis
        2. Amyloidosis
        3. Hydronephrosis
        4. Sickle Cell Nephropathy
      3. Acidifying agents
        1. Ammonium Chloride
        2. Calcium Chloride
        3. Arginine
      4. Sulfur toxicity
  5. Labs
    1. Arterial Blood Gas
      1. Arterial pH decreased
      2. Serum bicarbonate decreased
      3. PaCO2 decreased
        1. PaCO2 drops 1.2 mmHg per 1 meq/L bicarbonate fall
        2. Calculated PaCO2 = 1.5 x HCO3 + 8 (+/- 2)
          1. Useful in High Anion Gap Metabolic Acidosis
          2. Measured PaCO2 discrepancy: respiratory disorder
    2. Serum Chemistry panel
      1. Anion Gap
        1. Increased in high Anion Gap Metabolic Acidosis
      2. Excess Anion Gap <23 mEq/L
        1. Suggests Non-Anion Gap Metabolic Acidosis
      3. Serum Potassium
        1. Investigate normal Anion Gap Metabolic Acidosis
        2. See above
      4. Serum Chloride
        1. Elevated in normal Anion Gap Metabolic Acidosis
      5. Serum bicarbonate
        1. Decreased in increased Anion Gap Metabolic Acidosis
        2. Bicarbonate decrease matches Anion Gap increase
    3. Urinalysis with Urine pH
      1. Urine pH >6: Suggests Renal cause
      2. Urine pH <6: Suggests Gastrointestinal cause
    4. Urine Anion Gap (obtain urine electrolytes)
      1. Decreased Urine Anion Gap <-10
        1. Extrarenal Non-Anion Gap Metabolic Acidosis
      2. Increased Urine Anion Gap >+10
        1. Renal Non-Anion Gap Metabolic Acidosis
  6. References
    1. Arieff (1993) J Crit Illn 8(2): 224-46
    2. Narins (1982) Am J Med 72:496
    3. Narins (1980) Medicine 59:161-95
    4. Ghosh (2000) Fed Pract p. 23-33
    5. Rutecki (Dec 1997) Consultant, p. 3067-74
    6. Rutecki (Jan 1998) Consultant, p. 131-42

Metabolic acidosis, increased anion gap (IAG) (C0268036)

Concepts Disease or Syndrome (T047)
SnomedCT 25998009
English Metabolic acidosis, increased anion gap (IAG), NOS, Metabolic acidosis, increased anion gap (IAG) (disorder), Metabolic acidosis, increased anion gap (IAG)
Spanish acidosis metabólica, hiato aniónico aumentado (trastorno), acidosis metabólica, hiato aniónico aumentado, acidosis metabólica con anión gap aumentado, acidosis metabólica, brecha aniónica aumentada, acidosis metabólica, brecha aniónica aumentada (trastorno), acidosis metabólica, desequilibrio aniónico aumentado
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Metabolic acidosis (C0220981)

Definition (NCI) Increased acidity in the blood secondary to acid base imbalance. Causes include diabetes, kidney failure and shock.
Definition (NCI) A condition in which the blood is too acidic. It may be caused by severe illness or sepsis (bacteria in the bloodstream).
Concepts Pathologic Function (T046)
MSH D000138
ICD10 E87.2
SnomedCT 59455009
English ACIDOSIS METABOLIC, Acidosis, metabolic, METABOLIC ACIDOSIS, Metabolic acidosis, NOS, metabolic acidosis, metabolic acidosis (diagnosis), Acidosis metabolic, Metabolic acidosis NOS, Metabolic Acidoses, Acidosis, Metabolic, Acidoses, Metabolic, Metabolic Acidosis, acidosis metabolic, acidosis metabolics, acidosys metabolic, metabolic acidosis disorder, Metabolic acidosis (disorder), acidosis; metabolic, metabolic; acidosis, Metabolic acidosis
Italian Acidosi metabolica, Acidosi metabolica NAS
Dutch metabole acidose NAO, acidose; metabool, metabool; acidose, metabole acidose
French Acidose métabolique SAI, ACIDOSE METABOLIQUE, Acidose métabolique
German metabolische Azidose NNB, AZIDOSE METABOLISCH, metabolische Azidose
Portuguese Acidose metabólica NE, ACIDOSE METABOLICA, Acidose metabólica
Spanish Acidosis metabólica NEOM, ACIDOSIS METABOLICA, acidosis metabólica (trastorno), acidosis metabólica, Acidosis metabólica
Japanese 代謝性アシドーシス, 代謝性アシドーシスＮＯＳ, ﾀｲｼｬｾｲｱｼﾄﾞｰｼｽNOS, ﾀｲｼｬｾｲｱｼﾄﾞｰｼｽ
Czech Metabolická acidóza, Metabolická acidóza NOS
Hungarian Metabolicus acidosis, Metabolikus acidosis, Metabolikus acidosis k.m.n.
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Metabolic acidosis, normal anion gap (NAG) (C0268033)

Concepts Disease or Syndrome (T047)
SnomedCT 111377009
English Metabolic acidosis, normal anion gap (NAG), NOS, Metabolic acidosis, normal anion gap (NAG) (disorder), Metabolic acidosis, normal anion gap (NAG)
Spanish acidosis metabólica, hiato aniónico normal, acidosis metabólica, brecha aniónica normal (trastorno), acidosis metabólica, brecha aniónica normal, acidosis metabólica, hiato aniónico normal (trastorno), acidosis metabólica, anión gap normal, acidosis metabólica, desequilibrio aniónico normal
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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