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]