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METABOLIC ACIDOSIS-DIFFERENTIALS

Nephrology

METABOLIC ACIDOSIS-DIFFERENTIALS

CAUSES OF NORMAL ANION GAP ACIDOSIS (dec HCO 3 - + inc Cl - )
1. Loss of HCO 3 - due to diarrhea or proximal RTA
2. Increased organic acids (NH 4 + ; e.g., patients on total parenteral nutrition)
3. Increased endogenous acids (inability of the kidneys to excrete endogenous acids: renal failure or distal RTA)

CAUSES OF HIGH ANION GAP ACIDOSIS (dec HCO 3 - , no change in Cl - )
1. Severe CKD: decreased acid excretion (especialy NH 4 + )
2. Uremia: causes accumulation of sulfate, phosphate, urate
3. Ketoacidosis: diabetic, alcoholic, starvation
4. Lactic acidosis: drugs, toxins, circulatory compromise
5. Poisonings: salicylates, methanol, ethylene glycol, propylene glycol


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REFERENCES

1. Wilkinson, I. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press.
2. Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
3. Image: no reference available.

Ⓒ A. Manickam 2018

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