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    Metabolic acidosis can be caused by either a high anion gap or a normal anion gap. Conditions that can cause a high anion gap metabolic acidosis include ketoacidosis, lactic acidosis due to hypoxia or toxins, and the ingestion of toxins that are metabolized to acids like methanol. A normal anion gap metabolic acidosis can be caused by gastrointestinal or renal bicarbonate loss, as seen with diarrhea, renal tubular acidosis, or urologic procedures that involve bicarbonate loss. The document provides examples of specific diseases, medications, toxins, and procedures that can cause different types of metabolic acidosis.

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    Metabolic acidosis can be caused by either a high anion gap or a normal anion gap. Conditions that can cause a high anion gap metabolic acidosis include ketoacidosis, lactic acidosis due to hypoxia or toxins, and the ingestion of toxins that are metabolized to acids like methanol. A normal anion gap metabolic acidosis can be caused by gastrointestinal or renal bicarbonate loss, as seen with diarrhea, renal tubular acidosis, or urologic procedures that involve bicarbonate loss. The document provides examples of specific diseases, medications, toxins, and procedures that can cause different types of metabolic acidosis.

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    5 views2 pages

    Metabolic Acidosis - Endocrine and Metabolic Disorders - Merck Manuals Professional Edition

    Uploaded by

    maulidanabilah5
    Metabolic acidosis can be caused by either a high anion gap or a normal anion gap. Conditions that can cause a high anion gap metabolic acidosis include ketoacidosis, lactic acidosis due to hypoxia or toxins, and the ingestion of toxins that are metabolized to acids like methanol. A normal anion gap metabolic acidosis can be caused by gastrointestinal or renal bicarbonate loss, as seen with diarrhea, renal tubular acidosis, or urologic procedures that involve bicarbonate loss. The document provides examples of specific diseases, medications, toxins, and procedures that can cause different types of metabolic acidosis.

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    12/14/23, 7:59 AM Metabolic Acidosis - Endocrine and Metabolic Disorders - Merck Manuals Professional Edition

    Causes of Metabolic Acidosis

    Cause Examples

    High anion gap

    Alcohol (chronic abuse)


    Diabetes
    Ketoacidosis
    Fasting
    Undernutrition

    Alcohol (chronic abuse)


    Lactic acidosis (due to Primary hypoxia due to lung disorders
    physiologic processes) Seizures
    Shock

    Biguanides (rare except with acute kidney injury)


    Carbon monoxide
    Cyanide
    HIV nucleoside reverse transcriptase inhibitors
    Lactic acidosis (due to Iron
    exogenous toxins) Isoniazid
    Metformin
    Propofol
    Toluene (initially high gap; subsequent excretion of
    metabolites normalizes gap)

    Bacterial overgrowth
    D-Lactate generation
    Short bowel syndrome

    Renal failure —

    Rhabdomyolysis —

    Ethylene glycol (oxalate)


    Methanol (formate)
    Toxins metabolized to acids
    Paraldehyde (acetate, chloracetate)
    Salicylates

    Normal anion gap (hyperchloremic acidosis)

    https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/acid-base-regulation-and-disorders/metabolic-acidosis 1/2
    12/14/23, 7:59 AM Metabolic Acidosis - Endocrine and Metabolic Disorders - Merck Manuals Professional Edition

    Cause Examples

    Calcium chloride (CaCl2)


    Colostomy
    Gastrointestinal bicarbonate Diarrhea
    Enteric fistulas
    (HCO3−) loss
    Ileostomy
    Magnesium sulfate (MgSO4)
    Use of ion-exchange resins

    Arginine
    Ammonium chloride (NH4Cl)
    Parenteral infusion
    Lysine
    Rapid sodium chloride (NaCl) infusion

    Acetazolamide
    Hyperparathyroidism
    Renal HCO3− loss
    Renal tubular acidosis, types 1, 2, and 4
    Tubulointerstitial renal disease

    Ureteroileal conduit
    Urologic procedures
    Ureterosigmoidostomy

    Hypoaldosteronism
    Other Hyperkalemia
    Toluene (late)

    © 2023 Merck & Co., Inc., Rahway, NJ, USA and its affiliates. All rights reserved.

    MERCK MANUAL
    Professional Version

    https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/acid-base-regulation-and-disorders/metabolic-acidosis 2/2

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