High osmolar gap metabolic acidosis differential diagnosis: Difference between revisions

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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;" + | +
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| 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 547: Line 308:
* Zero or low [[Alcohol|alcohol level]]
* Zero or low [[Alcohol|alcohol level]]
|-
|-
| rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" + |Systemic
|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 650: Line 343:
* 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 718: Line 411:
| 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

Revision as of 16:35, 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 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
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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