Metabolic acidosis differential diagnosis: Difference between revisions

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| align="center" style="background:#F5F5F5;" + |Clinical manifestation and lab finding
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* May lead to pericarditis.
* May lead to [[pericarditis]]
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! colspan="2" align="center" style="background:#DCDCDC;" + |[[Renal failure]]<ref name="KrautMadias2016">{{cite journal|last1=Kraut|first1=Jeffrey A.|last2=Madias|first2=Nicolaos E.|title=Metabolic Acidosis of CKD: An Update|journal=American Journal of Kidney Diseases|volume=67|issue=2|year=2016|pages=307–317|issn=02726386|doi=10.1053/j.ajkd.2015.08.028}}</ref>
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Renal failure]]<ref name="KrautMadias2016">{{cite journal|last1=Kraut|first1=Jeffrey A.|last2=Madias|first2=Nicolaos E.|title=Metabolic Acidosis of CKD: An Update|journal=American Journal of Kidney Diseases|volume=67|issue=2|year=2016|pages=307–317|issn=02726386|doi=10.1053/j.ajkd.2015.08.028}}</ref>

Revision as of 16:34, 25 May 2018


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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sadaf Sharfaei M.D.[2]

Overview

Metabolic acidosis is occured in different situations such as poisoning, ketoacidosis, renal, gastrointestinal, cardiac, endocrine, and systemic diseases. 

Metabolic Acidosis Differential Diagnosis

Differential diagnosis of metabolic acidosis is as follow:[1][2][3][4]

To review differential diagnosis of high anion gap metabolic acidosis, click here.

To review differential diagnosis of high osmolar gap metabolic acidosis, click here.

To review differential diagnosis of metabolic acidosis and lactic acidosis, click here.

Category Disease Mechanism Clinical Paraclinical Gold standard diagnosis Other findings
Symptoms Signs Lab data
ABG CBC Chemistry Renal U/A
↑ acid
production
Loss of
bicarbonate
↓ renal acid
excretion
Fever N/V Diarrhea Dyspnea Toxic/ill BP Dehydration Level of consciousness HCO3 paCO2 O2 WBC Hb BS Cl K+ Na+ Ketones Lactic acid Serum AG[5] Osmolar gap[6] Bun Cr Urine pH Urine AG Urine ketone
Toxin/Medication[7] Alcohol poisoning[8][9] + + + ↓ ↑ + Nl Nl Nl + Nl or ↑ Nl or ↑ + + Clinical manifestation
+ + + + Nl Nl Nl Nl + Nl Nl Nl or ↑ + + Clinical manifestation
  • Not applicable
Toluene toxicity[11] + + + + ↓↓ Nl Nl Nl Nl Nl Nl Nl or ↑ Nl + Clinical manifestation
  • Most widely abused inhaled drugs
Salicylates overdose[12] + + + + + ↓↓ Nl Nl Nl to ↓ Nl Nl Clinical and elevated serum salicylate level
Metformin[13] + + + ± Agitated Nl Nl to ↑ Nl Nl Nl Nl Nl or ↑ Nl Clinical manifestation
Isoniazid[14] + + + + Agitated Nl Nl Nl Nl Nl Nl Nl Nl Nl or ↑ Nl Clinical manifestation
Acetazolamide[15] + + Nl Nl to ↓ Nl Nl Nl Nl Nl Nl Nl Nl Nl Nl Nl or ↑ Nl Clinical manifestation
  • Not applicable
Amphotericin B[16] + + + + + Nl to ↓ Nl Nl Nl Nl Nl Nl Nl Nl Nl Nl Clinical manifestation
  • Not applicable
Carbon monoxide poisoning[17] + + ± + Nl ↓↓ Nl to ↓ Nl Nl Nl Nl Nl Nl Nl Nl Nl Nl Clinical manifestation
  • Not applicable
Cyanide poisoning[18] + + + ± ↓↓ Nl to ↑ Nl Nl Nl Nl Nl Nl Nl or ↑ Nl Blood cyanide concentration
  • Not applicable
Category Disease ↑ acid
production
Loss of
bicarbonate
↓ renal acid
excretion
Fever N/V Diarrhea Dyspnea Toxic/ill BP Dehydration Level of consciousness HCO3 paCO2 O2 WBC Hb BS Cl K+ Na+ Ketones Lactic acid Serum AG Osmolar gap Bun Cr Urine pH Urine AG Urine ketone Gold standard diagnosis Other findings
Ketoacidosis Diabetic ketoacidosis[19] + + + + + + + Nl to ↓ Nl to ↑ ↑↑ Nl Nl to ↑ Nl + + Clinical + hyperglycemia + ketosis
  • Labs might show elevated K+ even in K+ depletion due to extravasation of intracellular K+ in exchanged with extracellular H+
Starvation[20] + + + + Nl Nl Nl Nl to ↓ Nl Nl Nl Nl Nl Nl + Clinical manifestation
Alcoholic ketoacidosis (Ethanol)[21] + + ± + ↓ ↑ + Agitated Nl to ↑ Nl to ↑ ↓ Nl ↑ Nl ↑↑ ↑↑ Nl + + Clinical manifestation + ketosis
Systemic Sepsis[22] + + + + + ↓ ↑ + Nl to ↓ Nl Nl Nl Nl Nl to ↑ Nl Nl Nl Clinical manifestation and lab finding
  • Not applicable
Ischemia[23] + + + + + ↓ ↑ Nl to ↓ Nl to ↑ Nl Nl Nl Nl Nl to ↑ Nl Nl Nl to ↑ Nl to ↑ Nl Clinical manifestation and lab finding
  • Not applicable
Lactic acidosis[24] + ± + + ↓ ↑ ± Agitated Nl to ↑ Nl Nl Nl Nl Nl Nl or ↑ Nl Clinical manifestation and lab finding
  • Not applicable
Renal Uremia[25] + + + + ↓ ↑ ± Nl to ↓ Nl Nl Nl Nl + Clinical manifestation and lab finding
Renal failure[26] + + + + Nl to ↓ Nl Nl Nl Renal function test
  • Not applicable
Renal tubular acidosis[27] Type I[28] + ± ± ↓ ↑ Nl Nl Nl Nl Nl Nl Nl Nl + Clinical manifestation and lab finding
Type II + ± ± ↓ ↑ Nl Nl Nl Nl Nl Nl Nl Nl Nl Nl Nl Nl Clinical manifestation and lab finding
  • Not applicable
Type IV + ± ± ± Nl Nl Nl Nl Nl Nl Nl Nl Nl Nl Nl Nl + Clinical manifestation and lab finding
Category Disease ↑ acid
production
Loss of
bicarbonate
↓ renal acid
excretion
Fever N/V Diarrhea Dyspnea Toxic/ill BP Dehydration Level of consciousness HCO3 paCO2 O2 WBC Hb BS Cl K+ Na+ Ketones Lactic acid Serum AG Osmolar gap Bun Cr Urine pH Urine AG Urine ketone Gold standard diagnosis Other findings
Heart Heart failure[29] + + ± + + ↓ ↑ + ↓ ↑ Nl Nl Nl Nl Nl Nl Nl Nl Nl to ↑ Nl to ↑ Nl Clinical manifestation+ echocardiogram
Myocardial infarction[30] + + + + ↓ ↑ ↓ ↑ Nl to ↓ Nl to ↑ Nl Nl Nl Nl Nl Nl Nl to ↑ Nl to ↑ Nl Clinical manifestation + ECG
  • Not applicable
GI Diarrhea[31] + ± + + + + Nl Nl Nl Nl Nl Nl Nl Nl Nl Stool exam
  • Not applicable
Hyperalimentation[32] + + + Nl Nl Nl Nl Nl Nl Nl Nl Nl Nl Nl Nl Clinical manifestation
  • Not applicable
Liver failure[33] + + + + + Confused Nl Nl ↓ ↑ Nl Nl Nl Nl Nl Nl Nl Liver biopsy
  • Not applicable
Endocrine Hyperparathyroidism[34] + + + Nl + Confused Nl Nl Nl Nl Nl Nl Nl Nl Nl Nl Nl Nl to ↑ Nl Nl PTH level
  • Not applicable
Addison's disease[35] + + + + Irritable Nl Nl Nl Nl Nl Nl Nl Nl Nl Nl Nl Hormone level
Category Disease ↑ acid
production
Loss of
bicarbonate
↓ renal acid
excretion
Fever N/V Diarrhea Dyspnea Toxic/ill BP Dehydration Level of consciousness HCO3 paCO2 O2 WBC Hb BS Cl K+ Na+ Ketones Lactic acid Serum AG Osmolar gap Bun Cr Urine pH Urine AG Urine ketone Gold standard diagnosis Other findings

References

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