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