Etiology

Ketoacidoses

• Alcoholic Ketoacidosis (AKA) (see Alcoholic Ketoacidosis, [[Alcoholic Ketoacidosis]] and Ethanol, [[Ethanol]])
• Diabetic Ketoacidosis (DKA) (see Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State, [[Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State]])
• Starvation Ketoacidosis (see Starvation Ketoacidosis, [[Starvation Ketoacidosis]])

Intoxications

• Diethylene Glycol Intoxication (see Diethylene Glycol, [[Diethylene Glycol]])
• Ethylene Glycol Intoxication (see Ethylene Glycol, [[Ethylene Glycol]])
• Formaldehyde Intoxication (see Formaldehyde, [[Formaldehyde]])
• Methanol Intoxication (see Methanol, [[Methanol]])
• Paraladehyde Intoxication (see Paraldehyde, [[Paraldehyde]])
• Propylene Glycol Intoxication (see Propylene Glycol, [[Propylene Glycol]])
• Pyroglutamic Acidosis (PCA, Pidolic Acid, Pyroglutamate, 5-Oxoproline) (see Pyroglutamic Acidosis, [[Pyroglutamic Acidosis]])
• Salicylate Intoxication (see Salicylates, [[Salicylates]])
• Toluene Intoxication (see Toluene, [[Toluene]])

Other

• Acute Kidney Injury (AKI) (see Acute Kidney Injury, [[Acute Kidney Injury]])
• Chronic Kidney Disease (CKD) (see Chronic Kidney Disease, [[Chronic Kidney Disease]])
• Lactic Acidosis (see Lactic Acidosis, [[Lactic Acidosis]])

---

Etiology (GOLDMARK Mnemonic)

• G: Glycols
  • Diethylene Glycol Intoxication (see Diethylene Glycol, [[Diethylene Glycol]])
  • Ethylene Glycol Intoxication (see Ethylene Glycol, [[Ethylene Glycol]])
  • Propylene Glycol Intoxication (see Propylene Glycol, [[Propylene Glycol]])
• O: 5-Oxoproline (Pyroglutamic Acid) (see Pyroglutamic Acidosis, [[Pyroglutamic Acidosis]])
• L: L-Lactic Acid (see Lactic Acidosis, [[Lactic Acidosis]])
• D: D-Lactic Acid (see Lactic Acidosis, [[Lactic Acidosis]])
• M: Methanol (see Methanol, [[Methanol]])
• A: Aspirin (see Salicylates, [[Salicylates]])
• R: Renal Failure
  • Acute Kidney Injury (AKI) (see Acute Kidney Injury, [[Acute Kidney Injury]])
  • Chronic Kidney Disease (CKD) (see Chronic Kidney Disease, [[Chronic Kidney Disease]])
• K: Ketoacidosis
  • Alcoholic Ketoacidosis (AKA) (see Alcoholic Ketoacidosis, [[Alcoholic Ketoacidosis]]
  • Diabetic Ketoacidosis (DKA) (see Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State, [[Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State]])
  • Starvation Ketoacidosis (see Starvation Ketoacidosis, [[Starvation Ketoacidosis]])

---

Diagnosis

Serum Chemistry

• Serum Bicarbonate: decreased
• Anion Gap (see Serum Anion Gap, [[Serum Anion Gap]]): elevated

Arterial Blood Gas (ABG) (see Arterial Blood Gas, [[Arterial Blood Gas]])

• Decreased Serum Bicarbonate with Respiratory Compensation: assessment of the appropriateness of respiratory compensation can be determined using standard rules of expected compensation (see Acid-Base, [[Acid-Base]])

Serum Osmolality (see Serum Osmolality, [[Serum Osmolality]])

• Osmolal Gap: variable (depending on the etiology)

---

Clinical Manifestations

Renal Manifestations

• Anion Gap Metabolic Acidosis (AGMA)

---

Treatment

• Treat Underlying Disorder

---

References

• Systematic review of current guidelines, and their evidence base, on risk of lactic acidosis after administration of contrast medium for patients receiving metformin. Radiology Jan 2010; 254:261-269
• Diagnostic Challenge in a Patient with Severe Anion Gap Metabolic Acidosis. Case Rep Crit Care. 2015;2015:272914. doi: 10.1155/2015/272914. Epub 2015 May 31 [MEDLINE]