High osmolar gap metabolic acidosis differential diagnosis: Difference between revisions

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{{CMG}}; {{AE}} {{SSH}}
{{CMG}}; {{AE}} {{SSH}}


'''Differential diagnosis of metabolic acidosis is as follow:'''<ref name="pmid17936961">{{cite journal |vauthors=Lim S |title=Metabolic acidosis |journal=Acta Med Indones |volume=39 |issue=3 |pages=145–50 |date=2007 |pmid=17936961 |doi= |url=}}</ref><ref name="MorrisLow2008">{{cite journal|last1=Morris|first1=C. G.|last2=Low|first2=J.|title=Metabolic acidosis in the critically ill: Part 1. Classification and pathophysiology|journal=Anaesthesia|volume=63|issue=3|year=2008|pages=294–301|issn=00032409|doi=10.1111/j.1365-2044.2007.05370.x}}</ref><ref name="pmid18336491">{{cite journal |vauthors=Morris CG, Low J |title=Metabolic acidosis in the critically ill: part 2. Causes and treatment |journal=Anaesthesia |volume=63 |issue=4 |pages=396–411 |date=April 2008 |pmid=18336491 |doi=10.1111/j.1365-2044.2007.05371.x |url=}}</ref><ref name="Casaletto2005">{{cite journal|last1=Casaletto|first1=Jennifer J.|title=Differential Diagnosis of Metabolic Acidosis|journal=Emergency Medicine Clinics of North America|volume=23|issue=3|year=2005|pages=771–787|issn=07338627|doi=10.1016/j.emc.2005.03.007}}</ref>
==High Osmolar Gap Metabolic Acidosis Differential Diagnosis==
'''Differential diagnosis of metabolic acidosis and lactic acidosis is as follow:'''<ref name="pmid17936961">{{cite journal |vauthors=Lim S |title=Metabolic acidosis |journal=Acta Med Indones |volume=39 |issue=3 |pages=145–50 |date=2007 |pmid=17936961 |doi= |url=}}</ref><ref name="MorrisLow2008">{{cite journal|last1=Morris|first1=C. G.|last2=Low|first2=J.|title=Metabolic acidosis in the critically ill: Part 1. Classification and pathophysiology|journal=Anaesthesia|volume=63|issue=3|year=2008|pages=294–301|issn=00032409|doi=10.1111/j.1365-2044.2007.05370.x}}</ref><ref name="pmid18336491">{{cite journal |vauthors=Morris CG, Low J |title=Metabolic acidosis in the critically ill: part 2. Causes and treatment |journal=Anaesthesia |volume=63 |issue=4 |pages=396–411 |date=April 2008 |pmid=18336491 |doi=10.1111/j.1365-2044.2007.05371.x |url=}}</ref><ref name="Casaletto2005">{{cite journal|last1=Casaletto|first1=Jennifer J.|title=Differential Diagnosis of Metabolic Acidosis|journal=Emergency Medicine Clinics of North America|volume=23|issue=3|year=2005|pages=771–787|issn=07338627|doi=10.1016/j.emc.2005.03.007}}</ref>


'''To review differential diagnosis of  high anion gap metabolic acidosis, click [[High anion gap metabolic acidosis differential diagnosis|here]].'''
'''To review differential diagnosis of  metabolic acidosis, click [[Metabolic acidosis differential diagnosis|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.'''


{|  
{|  
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! align="center" style="background:#4479BA; color: #FFFFFF;" + |Urine ketone
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Urine ketone
|-
|-
! rowspan="10" align="center" style="background:#4479BA; color: #FFFFFF;" + |Toxin/Medication<ref name="PhamXu2015">{{cite journal|last1=Pham|first1=Amy Quynh Trang|last2=Xu|first2=Li Hao Richie|last3=Moe|first3=Orson W.|title=Drug-Induced Metabolic Acidosis|journal=F1000Research|year=2015|issn=2046-1402|doi=10.12688/f1000research.7006.1}}</ref>
! rowspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" + |Toxin/Medication<ref name="PhamXu2015">{{cite journal|last1=Pham|first1=Amy Quynh Trang|last2=Xu|first2=Li Hao Richie|last3=Moe|first3=Orson W.|title=Drug-Induced Metabolic Acidosis|journal=F1000Research|year=2015|issn=2046-1402|doi=10.12688/f1000research.7006.1}}</ref>
! rowspan="2" align="center" style="background:#DCDCDC;" + |[[Alcohol poisoning]]<ref name="pmid15902789">{{cite journal |vauthors=Zehtabchi S, Sinert R, Baron BJ, Paladino L, Yadav K |title=Does ethanol explain the acidosis commonly seen in ethanol-intoxicated patients? |journal=Clin Toxicol (Phila) |volume=43 |issue=3 |pages=161–6 |date=2005 |pmid=15902789 |doi= |url=}}</ref><ref name="RobertsYates2015">{{cite journal|last1=Roberts|first1=Darren M.|last2=Yates|first2=Christopher|last3=Megarbane|first3=Bruno|last4=Winchester|first4=James F.|last5=Maclaren|first5=Robert|last6=Gosselin|first6=Sophie|last7=Nolin|first7=Thomas D.|last8=Lavergne|first8=Valéry|last9=Hoffman|first9=Robert S.|last10=Ghannoum|first10=Marc|title=Recommendations for the Role of Extracorporeal Treatments in the Management of Acute Methanol Poisoning|journal=Critical Care Medicine|volume=43|issue=2|year=2015|pages=461–472|issn=0090-3493|doi=10.1097/CCM.0000000000000708}}</ref>
! rowspan="2" align="center" style="background:#DCDCDC;" + |[[Alcohol poisoning]]<ref name="pmid15902789">{{cite journal |vauthors=Zehtabchi S, Sinert R, Baron BJ, Paladino L, Yadav K |title=Does ethanol explain the acidosis commonly seen in ethanol-intoxicated patients? |journal=Clin Toxicol (Phila) |volume=43 |issue=3 |pages=161–6 |date=2005 |pmid=15902789 |doi= |url=}}</ref><ref name="RobertsYates2015">{{cite journal|last1=Roberts|first1=Darren M.|last2=Yates|first2=Christopher|last3=Megarbane|first3=Bruno|last4=Winchester|first4=James F.|last5=Maclaren|first5=Robert|last6=Gosselin|first6=Sophie|last7=Nolin|first7=Thomas D.|last8=Lavergne|first8=Valéry|last9=Hoffman|first9=Robert S.|last10=Ghannoum|first10=Marc|title=Recommendations for the Role of Extracorporeal Treatments in the Management of Acute Methanol Poisoning|journal=Critical Care Medicine|volume=43|issue=2|year=2015|pages=461–472|issn=0090-3493|doi=10.1097/CCM.0000000000000708}}</ref>
! align="left" style="background:#DCDCDC;" + |
! align="left" style="background:#DCDCDC;" + |
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| align="left" style="background:#F5F5F5;" + |
| align="left" style="background:#F5F5F5;" + |
* Not applicable
* Not applicable
|-
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Toluene (toxicology)|Toluene toxicity]]<ref name="Camara-LemarroyRodríguez-Gutiérrez2015">{{cite journal|last1=Camara-Lemarroy|first1=Carlos Rodrigo|last2=Rodríguez-Gutiérrez|first2=René|last3=Monreal-Robles|first3=Roberto|last4=González-González|first4=José Gerardo|title=Acute toluene intoxication–clinical presentation, management and prognosis: a prospective observational study|journal=BMC Emergency Medicine|volume=15|issue=1|year=2015|issn=1471-227X|doi=10.1186/s12873-015-0039-0}}</ref>
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |↓↓
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |Nl or ↑
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |Clinical manifestation
| align="left" style="background:#F5F5F5;" + |
* Most widely abused inhaled drugs
|-
|-
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Salicylate intoxication|Salicylates overdose]]<ref name="WrightSop2015">{{cite journal|last1=Wright|first1=Dallas|last2=Sop|first2=Jessica|title=Normal anion gap salicylate poisoning|journal=The American Journal of Emergency Medicine|volume=33|issue=11|year=2015|pages=1714.e3–1714.e4|issn=07356757|doi=10.1016/j.ajem.2015.03.042}}</ref>
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Salicylate intoxication|Salicylates overdose]]<ref name="WrightSop2015">{{cite journal|last1=Wright|first1=Dallas|last2=Sop|first2=Jessica|title=Normal anion gap salicylate poisoning|journal=The American Journal of Emergency Medicine|volume=33|issue=11|year=2015|pages=1714.e3–1714.e4|issn=07356757|doi=10.1016/j.ajem.2015.03.042}}</ref>
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* Increased risk in patients with [[impaired renal function]]  
* Increased risk in patients with [[impaired renal function]]  
* [[Hepatic failure|Liver failure]]
* [[Hepatic failure|Liver failure]]
|-
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Isoniazid]]<ref name="pmid2304098">{{cite journal |vauthors=Watkins RC, Hambrick EL, Benjamin G, Chavda SN |title=Isoniazid toxicity presenting as seizures and metabolic acidosis |journal=J Natl Med Assoc |volume=82 |issue=1 |pages=57, 62, 64 |date=January 1990 |pmid=2304098 |pmc=2625939 |doi= |url=}}</ref>
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |Agitated
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl or ↑
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Clinical manifestation
| align="left" style="background:#F5F5F5;" + |
* [[Seizure]]
* [[Ataxia]]
|-
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Acetazolamide]]<ref name="TeppemaBalanos2007">{{cite journal|last1=Teppema|first1=Luc J.|last2=Balanos|first2=George M.|last3=Steinback|first3=Craig D.|last4=Brown|first4=Allison D.|last5=Foster|first5=Glen E.|last6=Duff|first6=Henry J.|last7=Leigh|first7=Richard|last8=Poulin|first8=Marc J.|title=Effects of Acetazolamide on Ventilatory, Cerebrovascular, and Pulmonary Vascular Responses to Hypoxia|journal=American Journal of Respiratory and Critical Care Medicine|volume=175|issue=3|year=2007|pages=277–281|issn=1073-449X|doi=10.1164/rccm.200608-1199OC}}</ref>
| align="center" style="background:#F5F5F5;" + | −
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | −
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | −
| align="center" style="background:#F5F5F5;" + | −
| align="center" style="background:#F5F5F5;" + | −
| align="center" style="background:#F5F5F5;" + | −
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |Nl to ↓
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl or ↑
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Clinical manifestation
| align="left" style="background:#F5F5F5;" + |
* Not applicable
|-
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Amphotericin B]]<ref name="BatesSu2001">{{cite journal|last1=Bates|first1=D. W.|last2=Su|first2=L.|last3=Yu|first3=D. T.|last4=Chertow|first4=G. M.|last5=Seger|first5=D. L.|last6=Gomes|first6=D. R. J.|last7=Dasbach|first7=E. J.|last8=Platt|first8=R.|title=Mortality and Costs of Acute Renal Failure Associated with Amphotericin B Therapy|journal=Clinical Infectious Diseases|volume=32|issue=5|year=2001|pages=686–693|issn=1058-4838|doi=10.1086/319211}}</ref>
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | −
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | −
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |Nl to ↓
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + | −
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Clinical manifestation
| align="left" style="background:#F5F5F5;" + |
* Not applicable
|-
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Carbon monoxide poisoning]]<ref name="pmid10333448">{{cite journal |vauthors=Piantadosi CA |title=Diagnosis and treatment of carbon monoxide poisoning |journal=Respir Care Clin N Am |volume=5 |issue=2 |pages=183–202 |date=June 1999 |pmid=10333448 |doi= |url=}}</ref>
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |±
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + | −
| align="center" style="background:#F5F5F5;" + |↓↓
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |Nl to ↓
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Clinical manifestation
| align="left" style="background:#F5F5F5;" + |
* Not applicable
|-
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Cyanide poisoning]]<ref name="pmid12352039">{{cite journal |vauthors=Baud FJ, Borron SW, Mégarbane B, Trout H, Lapostolle F, Vicaut E, Debray M, Bismuth C |title=Value of lactic acidosis in the assessment of the severity of acute cyanide poisoning |journal=Crit. Care Med. |volume=30 |issue=9 |pages=2044–50 |date=September 2002 |pmid=12352039 |doi=10.1097/01.CCM.0000026325.65944.7D |url=}}</ref>
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | −
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |±
| align="center" style="background:#F5F5F5;" + |↓↓
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |Nl to ↑
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl or ↑
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Blood [[cyanide]] concentration
| align="left" style="background:#F5F5F5;" + |
* Not applicable
|-
|-
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Category
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Category
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! align="center" style="background:#4479BA; color: #FFFFFF;" + |Other findings
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Other findings
|-
|-
| rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" + |Ketoacidosis
| rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Ketoacidosis
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Diabetic ketoacidosis]]<ref name="WolfsdorfAllgrove2014">{{cite journal|last1=Wolfsdorf|first1=Joseph I|last2=Allgrove|first2=Jeremy|last3=Craig|first3=Maria E|last4=Edge|first4=Julie|last5=Glaser|first5=Nicole|last6=Jain|first6=Vandana|last7=Lee|first7=Warren WR|last8=Mungai|first8=Lucy NW|last9=Rosenbloom|first9=Arlan L|last10=Sperling|first10=Mark A|last11=Hanas|first11=Ragnar|title=Diabetic ketoacidosis and hyperglycemic hyperosmolar state|journal=Pediatric Diabetes|volume=15|issue=S20|year=2014|pages=154–179|issn=1399543X|doi=10.1111/pedi.12165}}</ref>  
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Diabetic ketoacidosis]]<ref name="WolfsdorfAllgrove2014">{{cite journal|last1=Wolfsdorf|first1=Joseph I|last2=Allgrove|first2=Jeremy|last3=Craig|first3=Maria E|last4=Edge|first4=Julie|last5=Glaser|first5=Nicole|last6=Jain|first6=Vandana|last7=Lee|first7=Warren WR|last8=Mungai|first8=Lucy NW|last9=Rosenbloom|first9=Arlan L|last10=Sperling|first10=Mark A|last11=Hanas|first11=Ragnar|title=Diabetic ketoacidosis and hyperglycemic hyperosmolar state|journal=Pediatric Diabetes|volume=15|issue=S20|year=2014|pages=154–179|issn=1399543X|doi=10.1111/pedi.12165}}</ref>  
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
Line 476: Line 268:
| align="left" style="background:#F5F5F5;" + |
| align="left" style="background:#F5F5F5;" + |
* Labs might show elevated K<sup>+</sup> even in K<sup>+</sup> depletion due to extravasation of [[intracellular]] K+ in exchanged with extracellular H<sup>+</sup>
* Labs might show elevated K<sup>+</sup> even in K<sup>+</sup> depletion due to extravasation of [[intracellular]] K+ in exchanged with extracellular H<sup>+</sup>
|-
! colspan="2" align="center" style="background:#DCDCDC;" + |Starvation<ref name="pmid27752032">{{cite journal |vauthors=Mostert M, Bonavia A |title=Starvation Ketoacidosis as a Cause of Unexplained Metabolic Acidosis in the Perioperative Period |journal=Am J Case Rep |volume=17 |issue= |pages=755–758 |date=October 2016 |pmid=27752032 |pmc=5070574 |doi= |url=}}</ref>
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | −
| align="center" style="background:#F5F5F5;" + | −
| align="center" style="background:#F5F5F5;" + | −
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | −
| align="center" style="background:#F5F5F5;" + | −
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl to ↓
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | −
| align="center" style="background:#F5F5F5;" + |Clinical manifestation
| align="left" style="background:#F5F5F5;" + |
* [[Refeeding syndrome]] may occur during or after treatment 
|-
|-
! colspan="2" align="center" style="background:#DCDCDC;" + |Alcoholic ketoacidosis ([[Ethanol]])<ref name="pmid28613672">{{cite journal |vauthors=Howard RD, Bokhari SRA |title= |journal= |volume= |issue= |pages= |date= |pmid=28613672 |doi= |url=}}</ref>
! colspan="2" align="center" style="background:#DCDCDC;" + |Alcoholic ketoacidosis ([[Ethanol]])<ref name="pmid28613672">{{cite journal |vauthors=Howard RD, Bokhari SRA |title= |journal= |volume= |issue= |pages= |date= |pmid=28613672 |doi= |url=}}</ref>
Line 546: Line 304:
* Zero or low [[Alcohol|alcohol level]]
* Zero or low [[Alcohol|alcohol level]]
|-
|-
| rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" + |Systemic
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Systemic
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Sepsis]]<ref name="pmid28149822">{{cite journal |vauthors=Ganesh K, Sharma RN, Varghese J, Pillai MG |title=A profile of metabolic acidosis in patients with sepsis in an Intensive Care Unit setting |journal=Int J Crit Illn Inj Sci |volume=6 |issue=4 |pages=178–181 |date=2016 |pmid=28149822 |pmc=5225760 |doi=10.4103/2229-5151.195417 |url=}}</ref>
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | −
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |↓ ↑
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |Nl to ↓
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl to ↑
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + | −
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Clinical manifestation and lab finding
| align="left" style="background:#F5F5F5;" + |
* Not applicable
|-
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Ischemia]]<ref name="KimmounNovy2015">{{cite journal|last1=Kimmoun|first1=Antoine|last2=Novy|first2=Emmanuel|last3=Auchet|first3=Thomas|last4=Ducrocq|first4=Nicolas|last5=Levy|first5=Bruno|title=Hemodynamic consequences of severe lactic acidosis in shock states: from bench to bedside|journal=Critical Care|volume=19|issue=1|year=2015|issn=1364-8535|doi=10.1186/s13054-015-0896-7}}</ref>
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | −
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | −
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |↓ ↑
| align="center" style="background:#F5F5F5;" + |Nl to ↓
| align="center" style="background:#F5F5F5;" + |Nl to ↑
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl to ↑
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl to ↑
| align="center" style="background:#F5F5F5;" + |Nl to ↑
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + | −
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Clinical manifestation and lab finding
| align="left" style="background:#F5F5F5;" + |
* Not applicable
|-
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Lactic acidosis]]<ref name="KrautIngelfinger2014">{{cite journal|last1=Kraut|first1=Jeffrey A.|last2=Ingelfinger|first2=Julie R.|last3=Madias|first3=Nicolaos E.|title=Lactic Acidosis|journal=New England Journal of Medicine|volume=371|issue=24|year=2014|pages=2309–2319|issn=0028-4793|doi=10.1056/NEJMra1309483}}</ref>
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Lactic acidosis]]<ref name="KrautIngelfinger2014">{{cite journal|last1=Kraut|first1=Jeffrey A.|last2=Ingelfinger|first2=Julie R.|last3=Madias|first3=Nicolaos E.|title=Lactic Acidosis|journal=New England Journal of Medicine|volume=371|issue=24|year=2014|pages=2309–2319|issn=0028-4793|doi=10.1056/NEJMra1309483}}</ref>
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
Line 649: Line 339:
* Not applicable
* Not applicable
|-
|-
| rowspan="5" align="center" style="background:#4479BA; color: #FFFFFF;" + |Renal
| rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Renal
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Uremia]]<ref name="BrownMelamed2018">{{cite journal|last1=Brown|first1=Denver|last2=Melamed|first2=Michal L.|title=New Frontiers in Treating Uremic Metabolic Acidosis|journal=Clinical Journal of the American Society of Nephrology|volume=13|issue=1|year=2018|pages=4–5|issn=1555-9041|doi=10.2215/CJN.11771017}}</ref>
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Uremia]]<ref name="BrownMelamed2018">{{cite journal|last1=Brown|first1=Denver|last2=Melamed|first2=Michal L.|title=New Frontiers in Treating Uremic Metabolic Acidosis|journal=Clinical Journal of the American Society of Nephrology|volume=13|issue=1|year=2018|pages=4–5|issn=1555-9041|doi=10.2215/CJN.11771017}}</ref>
| align="center" style="background:#F5F5F5;" + | −
| align="center" style="background:#F5F5F5;" + | −
Line 717: Line 407:
| align="left" style="background:#F5F5F5;" + |
| align="left" style="background:#F5F5F5;" + |
* Not applicable
* Not applicable
|-
! rowspan="3" align="center" style="background:#DCDCDC;" + |[[Renal tubular acidosis]]<ref name="Gil-PeñaMejía2014">{{cite journal|last1=Gil-Peña|first1=Helena|last2=Mejía|first2=Natalia|last3=Santos|first3=Fernando|title=Renal Tubular Acidosis|journal=The Journal of Pediatrics|volume=164|issue=4|year=2014|pages=691–698.e1|issn=00223476|doi=10.1016/j.jpeds.2013.10.085}}</ref>
! align="center" style="background:#DCDCDC;" + |Type I<ref name="Hemstreet2004">{{cite journal|last1=Hemstreet|first1=Brian A|title=Antimicrobial-Associated Renal Tubular Acidosis|journal=Annals of Pharmacotherapy|volume=38|issue=6|year=2004|pages=1031–1038|issn=1060-0280|doi=10.1345/aph.1D573}}</ref>
| align="center" style="background:#F5F5F5;" + | −
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |±
| align="center" style="background:#F5F5F5;" + |±
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | −
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |↓ ↑
| align="center" style="background:#F5F5F5;" + | −
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | −
| align="center" style="background:#F5F5F5;" + |Clinical manifestation and lab finding
| align="left" style="background:#F5F5F5;" + |
* Associated with [[Autoimmunity|autoimmune diseases]]
* [[Delayed milestone|Growth retardation]] in children
|-
! align="center" style="background:#DCDCDC;" + |Type II
| align="center" style="background:#F5F5F5;" + | −
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | −
| align="center" style="background:#F5F5F5;" + |±
| align="center" style="background:#F5F5F5;" + |±
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | −
| align="center" style="background:#F5F5F5;" + |↓ ↑
| align="center" style="background:#F5F5F5;" + | −
| align="center" style="background:#F5F5F5;" + | −
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Clinical manifestation and lab finding
| align="left" style="background:#F5F5F5;" + |
* Not applicable
|-
! align="center" style="background:#DCDCDC;" + |Type IV
| align="center" style="background:#F5F5F5;" + | −
| align="center" style="background:#F5F5F5;" + | −
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |±
| align="center" style="background:#F5F5F5;" + |±
| align="center" style="background:#F5F5F5;" + |±
| align="center" style="background:#F5F5F5;" + | −
| align="center" style="background:#F5F5F5;" + | −
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | −
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Clinical manifestation and lab finding
| align="left" style="background:#F5F5F5;" + |
* [[Hypoaldosteronism]]
|-
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Category
! colspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Disease
! align="center" style="background:#4479BA; color: #FFFFFF;" + |↑ acid <br>production
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Loss of <br>bicarbonate
! align="center" style="background:#4479BA; color: #FFFFFF;" + |↓ renal acid <br>excretion
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Fever
! align="center" style="background:#4479BA; color: #FFFFFF;" + |N/V
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Diarrhea
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Dyspnea
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Toxic/ill
! align="center" style="background:#4479BA; color: #FFFFFF;" + |BP
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Dehydration
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Level of consciousness
! align="center" style="background:#4479BA; color: #FFFFFF;" + |HCO<sub>3</sub><sup>−</sup>
! align="center" style="background:#4479BA; color: #FFFFFF;" + |paCO<sub>2</sub>
! align="center" style="background:#4479BA; color: #FFFFFF;" + |O<sub>2</sub>
! align="center" style="background:#4479BA; color: #FFFFFF;" + |WBC
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Hb
! align="center" style="background:#4479BA; color: #FFFFFF;" + |BS
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Cl<sup>−</sup>
! align="center" style="background:#4479BA; color: #FFFFFF;" + |K<sup>+</sup>
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Na<sup>+</sup>
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Ketones
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Lactic acid
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Serum AG
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Osmolar gap
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Bun
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Cr
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Urine pH
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Urine AG
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Urine ketone
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Gold standard diagnosis
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Other findings
|-
| rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Heart
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Heart failure]]<ref name="ParkChoi2015">{{cite journal|last1=Park|first1=Jin Joo|last2=Choi|first2=Dong-Ju|last3=Yoon|first3=Chang-Hwan|last4=Oh|first4=Il-Young|last5=Lee|first5=Ju Hyun|last6=Ahn|first6=Soyeon|last7=Yoo|first7=Byung-Su|last8=Kang|first8=Seok-Min|last9=Kim|first9=Jae-Joong|last10=Baek|first10=Sang-Hong|last11=Cho|first11=Myeong-Chan|last12=Jeon|first12=Eun-Seok|last13=Chae|first13=Shung Chull|last14=Ryu|first14=Kyu-Hyung|last15=Oh|first15=Byung-Hee|title=The prognostic value of arterial blood gas analysis in high-risk acute heart failure patients: an analysis of the Korean Heart Failure (KorHF) registry|journal=European Journal of Heart Failure|volume=17|issue=6|year=2015|pages=601–611|issn=13889842|doi=10.1002/ejhf.276}}</ref>
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | −
| align="center" style="background:#F5F5F5;" + | −
| align="center" style="background:#F5F5F5;" + |±
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |↓ ↑
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |↓ ↑
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl to ↑
| align="center" style="background:#F5F5F5;" + |Nl to ↑
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + | −
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Clinical manifestation+ [[echocardiogram]]
| align="left" style="background:#F5F5F5;" + |
* [[Hypoalbuminemia]]
* Elevated [[Natriuretic peptides|serum natriuretic peptide]]
|-
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Myocardial infarction]]<ref name="MannBajulaiye2014">{{cite journal|last1=Mann|first1=Sarah|last2=Bajulaiye|first2=Akinyemi|last3=Sturgeon|first3=Kathleen|last4=Sabri|first4=Abdelkarim|last5=Muthukumaran|first5=Geetha|last6=Libonati|first6=Joseph R.|title=Effects of acute angiotensin II on ischemia reperfusion injury following myocardial infarction|journal=Journal of the Renin-Angiotensin-Aldosterone System|volume=16|issue=1|year=2014|pages=13–22|issn=1470-3203|doi=10.1177/1470320314554963}}</ref>
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |↓ ↑
| align="center" style="background:#F5F5F5;" + | −
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |↓ ↑
| align="center" style="background:#F5F5F5;" + |Nl to ↓
| align="center" style="background:#F5F5F5;" + |Nl to ↑
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl to ↑
| align="center" style="background:#F5F5F5;" + |Nl to ↑
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + | −
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Clinical manifestation + [[ECG]]
| align="left" style="background:#F5F5F5;" + |
* Not applicable
|-
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" + |GI
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Diarrhea]]<ref name="GuerrantVan Gilder2001">{{cite journal|last1=Guerrant|first1=R. L.|last2=Van Gilder|first2=T.|last3=Steiner|first3=T. S.|last4=Thielman|first4=N. M.|last5=Slutsker|first5=L.|last6=Tauxe|first6=R. V.|last7=Hennessy|first7=T.|last8=Griffin|first8=P. M.|last9=DuPont|first9=H.|last10=Bradley Sack|first10=R.|last11=Tarr|first11=P.|last12=Neill|first12=M.|last13=Nachamkin|first13=I.|last14=Reller|first14=L. B.|last15=Osterholm|first15=M. T.|last16=Bennish|first16=M. L.|last17=Pickering|first17=L. K.|title=Practice Guidelines for the Management of Infectious Diarrhea|journal=Clinical Infectious Diseases|volume=32|issue=3|year=2001|pages=331–351|issn=1058-4838|doi=10.1086/318514}}</ref>
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | −
| align="center" style="background:#F5F5F5;" + |±
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |May be lethargic
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |[[Stool examination|Stool exam]]
| align="left" style="background:#F5F5F5;" + |
* Not applicable
|-
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Hyperalimentation]]<ref name="ErlingssonHerard2009">{{cite journal|last1=Erlingsson|first1=Styrbjörn|last2=Herard|first2=Sebastian|last3=Dahlqvist Leinhard|first3=Olof|last4=Lindström|first4=Torbjörb|last5=Länne|first5=Toste|last6=Borga|first6=Magnus|last7=Nystrom|first7=Fredrik H.|title=Men develop more intraabdominal obesity and signs of the metabolic syndrome after hyperalimentation than women|journal=Metabolism|volume=58|issue=7|year=2009|pages=995–1001|issn=00260495|doi=10.1016/j.metabol.2009.02.028}}</ref>
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |Clinical manifestation
| align="left" style="background:#F5F5F5;" + |
* Not applicable
|-
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Liver failure]]<ref name="LangeBojunga2009">{{cite journal|last1=Lange|first1=Christian M.|last2=Bojunga|first2=Jörg|last3=Hofmann|first3=Wolf Peter|last4=Wunder|first4=Katrin|last5=Mihm|first5=Ulrike|last6=Zeuzem|first6=Stefan|last7=Sarrazin|first7=Christoph|title=Severe lactic acidosis during treatment of chronic hepatitis B with entecavir in patients with impaired liver function|journal=Hepatology|volume=50|issue=6|year=2009|pages=2001–2006|issn=02709139|doi=10.1002/hep.23346}}</ref>
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |Confused
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |↓ ↑
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |[[Liver biopsy]]
| align="left" style="background:#F5F5F5;" + |
* Not applicable
|-
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Endocrine
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Hyperparathyroidism]]<ref name="BilezikianPotts2002">{{cite journal|last1=Bilezikian|first1=John P.|last2=Potts|first2=John T.|last3=Fuleihan|first3=Ghada El-Hajj|last4=Kleerekoper|first4=Michael|last5=Neer|first5=Robert|last6=Peacock|first6=Munro|last7=Rastad|first7=Jonas|last8=Silverberg|first8=Shonni J.|last9=Udelsman|first9=Robert|last10=Wells|first10=Samuel A.|title=Summary Statement from a Workshop on Asymptomatic Primary Hyperparathyroidism: A Perspective for the 21st Century|journal=The Journal of Clinical Endocrinology & Metabolism|volume=87|issue=12|year=2002|pages=5353–5361|issn=0021-972X|doi=10.1210/jc.2002-021370}}</ref>
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | −
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |Confused
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl to ↑
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |[[Parathyroid hormone|PTH]] level
| align="left" style="background:#F5F5F5;" + |
* Not applicable
|-
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Addison's disease]]<ref name="TenNew2001">{{cite journal|last1=Ten|first1=Svetlana|last2=New|first2=Maria|last3=Maclaren|first3=Noel|title=Addison’s Disease 2001|journal=The Journal of Clinical Endocrinology & Metabolism|volume=86|issue=7|year=2001|pages=2909–2922|issn=0021-972X|doi=10.1210/jcem.86.7.7636}}</ref>
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | −
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + | −
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |Irritable
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |Nl
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |−
| align="center" style="background:#F5F5F5;" + |[[Hormone]] level
| align="left" style="background:#F5F5F5;" + |
* [[Weakness]]
* [[Hyperpigmentation]]
* [[Adrenal crisis|Adrenal Crisis]]
|-
|-
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Category
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Category
Line 1,134: Line 442:
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Other findings
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Other findings
|}
|}
==References==
==References==
{{reflist|2}}
{{reflist|2}}

Latest revision as of 16:41, 30 May 2018


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

High Osmolar Gap Metabolic Acidosis Differential Diagnosis

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

To review differential diagnosis of metabolic 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
Salicylates overdose[11] + − − − + − + + ↓ + ↓ ↓ ↓↓ ↓ Nl Nl Nl to ↓ Nl ↓ Nl − ↑ ↑ ↑ ↑ ↑ ↓ − − Clinical and elevated serum salicylate level
Metformin[12] + − − − + − − + ↓ ± Agitated ↓ ↓ Nl Nl to ↑ ↓ ↓ Nl Nl Nl Nl ↑ ↑ ↑ Nl or ↑ Nl ↓ − − Clinical manifestation
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[13] + − − + + + + + ↓ + ↓ ↓ ↓ 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+
Alcoholic ketoacidosis (Ethanol)[14] + − − − + ± − + ↓ ↑ + Agitated ↓ ↓ ↓ Nl to ↑ Nl to ↑ ↓ Nl ↑ Nl ↓ ↓ ↑↑ ↑ ↑ ↑↑ ↑ Nl ↓ + + Clinical manifestation + ketosis
Systemic Lactic acidosis[15] + − − ± + − − + ↓ ↑ ± Agitated ↓ ↓ ↓ Nl to ↑ ↓ Nl Nl Nl Nl Nl ↑ ↑ ↑ Nl or ↑ Nl ↓ − − Clinical manifestation and lab finding
  • Not applicable
Renal Uremia[16] − − + + + − − + ↓ ↑ ± ↓ ↓ ↓ Nl to ↓ ↑ ↓ Nl Nl ↑ ↑ Nl Nl ↑ ↑ ↑ ↑ ↓ + − Clinical manifestation and lab finding
Renal failure[17] − − + − + − − + ↓ + ↓ ↓ ↓ Nl to ↓ ↑ ↓ Nl ↑ ↑ ↓ Nl Nl ↑ ↑ ↑ ↑ ↓ − − Renal function test
  • 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

References

  1. ↑ Lim S (2007). "Metabolic acidosis". Acta Med Indones. 39 (3): 145–50. PMID 17936961.
  2. ↑ Morris, C. G.; Low, J. (2008). "Metabolic acidosis in the critically ill: Part 1. Classification and pathophysiology". Anaesthesia. 63 (3): 294–301. doi:10.1111/j.1365-2044.2007.05370.x. ISSN 0003-2409.
  3. ↑ Morris CG, Low J (April 2008). "Metabolic acidosis in the critically ill: part 2. Causes and treatment". Anaesthesia. 63 (4): 396–411. doi:10.1111/j.1365-2044.2007.05371.x. PMID 18336491.
  4. ↑ Casaletto, Jennifer J. (2005). "Differential Diagnosis of Metabolic Acidosis". Emergency Medicine Clinics of North America. 23 (3): 771–787. doi:10.1016/j.emc.2005.03.007. ISSN 0733-8627.
  5. ↑ Brubaker RH, Meseeha M. High Anion Gap Metabolic Acidosis. [Updated 2017 Oct 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2018 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448090/
  6. ↑ Kraut JA, Xing SX (September 2011). "Approach to the evaluation of a patient with an increased serum osmolal gap and high-anion-gap metabolic acidosis". Am. J. Kidney Dis. 58 (3): 480–4. doi:10.1053/j.ajkd.2011.05.018. PMID 21794966.
  7. ↑ Pham, Amy Quynh Trang; Xu, Li Hao Richie; Moe, Orson W. (2015). "Drug-Induced Metabolic Acidosis". F1000Research. doi:10.12688/f1000research.7006.1. ISSN 2046-1402.
  8. ↑ Zehtabchi S, Sinert R, Baron BJ, Paladino L, Yadav K (2005). "Does ethanol explain the acidosis commonly seen in ethanol-intoxicated patients?". Clin Toxicol (Phila). 43 (3): 161–6. PMID 15902789.
  9. ↑ Roberts, Darren M.; Yates, Christopher; Megarbane, Bruno; Winchester, James F.; Maclaren, Robert; Gosselin, Sophie; Nolin, Thomas D.; Lavergne, Valéry; Hoffman, Robert S.; Ghannoum, Marc (2015). "Recommendations for the Role of Extracorporeal Treatments in the Management of Acute Methanol Poisoning". Critical Care Medicine. 43 (2): 461–472. doi:10.1097/CCM.0000000000000708. ISSN 0090-3493.
  10. ↑ Ashurst JV, Nappe TM. Toxicity, Isopropanol. [Updated 2018 Mar 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2018 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK493181/
  11. ↑ Wright, Dallas; Sop, Jessica (2015). "Normal anion gap salicylate poisoning". The American Journal of Emergency Medicine. 33 (11): 1714.e3–1714.e4. doi:10.1016/j.ajem.2015.03.042. ISSN 0735-6757.
  12. ↑ Galiero, Francesca; Consani, Giovanni; Biancofiore, Gianni; Ruschi, Stefano; Forfori, Francesco (2018). "Metformin intoxication: Vasopressin's key role in the management of severe lactic acidosis". The American Journal of Emergency Medicine. 36 (2): 341.e5–341.e6. doi:10.1016/j.ajem.2017.10.057. ISSN 0735-6757.
  13. ↑ Wolfsdorf, Joseph I; Allgrove, Jeremy; Craig, Maria E; Edge, Julie; Glaser, Nicole; Jain, Vandana; Lee, Warren WR; Mungai, Lucy NW; Rosenbloom, Arlan L; Sperling, Mark A; Hanas, Ragnar (2014). "Diabetic ketoacidosis and hyperglycemic hyperosmolar state". Pediatric Diabetes. 15 (S20): 154–179. doi:10.1111/pedi.12165. ISSN 1399-543X.
  14. ↑ Howard RD, Bokhari S. PMID 28613672. Vancouver style error: initials (help); Missing or empty |title= (help)
  15. ↑ Kraut, Jeffrey A.; Ingelfinger, Julie R.; Madias, Nicolaos E. (2014). "Lactic Acidosis". New England Journal of Medicine. 371 (24): 2309–2319. doi:10.1056/NEJMra1309483. ISSN 0028-4793.
  16. ↑ Brown, Denver; Melamed, Michal L. (2018). "New Frontiers in Treating Uremic Metabolic Acidosis". Clinical Journal of the American Society of Nephrology. 13 (1): 4–5. doi:10.2215/CJN.11771017. ISSN 1555-9041.
  17. ↑ Kraut, Jeffrey A.; Madias, Nicolaos E. (2016). "Metabolic Acidosis of CKD: An Update". American Journal of Kidney Diseases. 67 (2): 307–317. doi:10.1053/j.ajkd.2015.08.028. ISSN 0272-6386.
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