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Table 37.5

Causes of Metabolic Acidosis

With increased anion gap

Ketoacidosis

  • Diabetic ketoacidosis
  • Alcoholic ketoacidosis*
  • Starvation ketoacidosis
Lactic acidosis
  • Inadequate tissue perfusion due to hypotension, low cardiac output or sepsis
  • Prolonged hypoxemia
  • Muscle contraction: status epilepticus
  • Metformin
Renal failure
  • Chronic uraemic acidosis
  • Acute renal failure
Toxins With normal anion gap (hyperchloraemic acidosis)

Renal

  • Renal tubular acidosis
  • Carbonic anhydrase inhibitors
Gastrointestinal
  • Severe diarrhoea
  • Obstructed ileal conduit
  • Small bowel fistula
  • Uretero-enterostomy
  • Drainage of pancreatic or biliary secretions
  • Small bowel fistula
Others
  • Recovery from ketoacidosis
  • Infusion of normal saline

* Alcoholic ketoacidosis is due to alcohol binge plus starvation, and is often associated with pancreatitis; hyperglycaemia may occur but is mild (<15 mmol/L).