Metabolic Acidosis

Normal anion gap metabolic acidosis

  • U            Ureteric diversion
  • S             Small bowel fistula
  • E             Extra chloride (ED resuscitation) or HCl ingestion
  • D            DKA (resolving)
  • C             Carbonic anhydrase inhibitors
  • A             Addisons (Type 4 RTA)
  • R             Renal tubular acidosis types 1, 2, and 4
  • P             Pancreatic fistula

Increased anion gap metabolic acidosis

  • M            Methanol (formic acid), metformin
  • U            Uraemia (including aminoglycosides)
  • R            Renal failure (Uric acid)
  • K            Ketoacidosis (alcohol, diabetes (acute), starvation)
  • L            Lactic acidosis
  • E            Ethanol
  • S            Salicylates
  • E            Ethylene glycol (glycolic acid)
  • P            Paraldehyde, propylene glycol
  • T            Toluene
  • I             Iron, isoniazid
  • C            Cyanide and carbon monoxide

Low anion gap

  • Increase in unmeasured cations (Increased Li, K, Ca, Mg, and IgG)
    • Lithium toxicity
    • Hypercalcaemia
    • Hypermagnesaemia
    • Hyperkalaemia
    • IgG (Multiple Myeloma)
  • Decreased unmeasured anions (Decreased PO4, albumin)
    • HYPOalbuminaemia, HYPOphosphatemia
  • Chloride over-estimation (anion)
    • Bromide toxicity (Read as increased chloride)
    • Iodide toxicity
    • Hypercholesterolemia

Clinical

  • Respiratory
    • Hyperventilation
    • Shift of Oxy-Hb curve to right
  • Cardiovascular
    • Myocardial depression
    • Tissue catecholamine resistance
    • Pulmonary vasoconstriction
    • Hyperkalaemia

Correction

  • Treat underlying cause
  • Supportive therapy
  • IV bicarbonate controversial – usually not helpful
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