Metabolic acidosis differential diagnosis: Difference between revisions
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[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Metabolic_acidosis]] | |||
{{CMG}}; {{AE}} {{SSH}} | {{CMG}}; {{AE}} {{SSH}} | ||
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'''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> | '''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> | ||
'''To review differential diagnosis of high anion gap metabolic acidosis, click here.''' | '''To review differential diagnosis of high anion gap metabolic acidosis, click [[High anion gap metabolic acidosis differential diagnosis|here]].''' | ||
'''To review differential diagnosis of high osmolar gap metabolic acidosis, click here.''' | '''To review differential diagnosis of high osmolar gap metabolic acidosis, click [[High osmolar gap metabolic acidosis differential diagnosis|here]].''' | ||
'''To review differential diagnosis of metabolic acidosis and lactic acidosis, click here.''' | '''To review differential diagnosis of metabolic acidosis and lactic acidosis, click [[Metabolic acidosis and lactic acidosis differential diagnosis|here]].''' | ||
{| | {| | ||
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! align="center" style="background:#4479BA; color: #FFFFFF;" + |BP | ! align="center" style="background:#4479BA; color: #FFFFFF;" + |BP | ||
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Dehydration | ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Dehydration | ||
! align="center" style="background:#4479BA; color: #FFFFFF;" + | | ! 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;" + |HCO<sub>3</sub><sup>−</sup> | ||
! align="center" style="background:#4479BA; color: #FFFFFF;" + |paCO<sub>2</sub> | ! align="center" style="background:#4479BA; color: #FFFFFF;" + |paCO<sub>2</sub> | ||
| Line 100: | Line 100: | ||
| align="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 | | align="center" style="background:#F5F5F5;" + |Clinical manifestation | ||
| align="left" style="background:#F5F5F5;" + | | | align="left" style="background:#F5F5F5;" + | | ||
* Positive urine [[oxalate]] crystals in [[Ethylene glycol|ethylene glycol poisoning]] | * Positive urine [[oxalate]] crystals in [[Ethylene glycol|ethylene glycol poisoning]] | ||
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| align="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 | | align="center" style="background:#F5F5F5;" + |Clinical manifestation | ||
| align="left" style="background:#F5F5F5;" + | | | align="left" style="background:#F5F5F5;" + | | ||
* 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> | ! 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> | ||
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| align="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 | | align="center" style="background:#F5F5F5;" + |Clinical manifestation | ||
| align="left" style="background:#F5F5F5;" + | | | align="left" style="background:#F5F5F5;" + | | ||
* Most widely abused inhaled drugs | * Most widely abused inhaled drugs | ||
| Line 236: | Line 237: | ||
| align="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 | | align="center" style="background:#F5F5F5;" + |Clinical manifestation | ||
| align="left" style="background:#F5F5F5;" + | | | align="left" style="background:#F5F5F5;" + | | ||
* Increased risk in patients with impaired renal function | * Increased risk in patients with [[impaired renal function]] | ||
* [[Hepatic failure|Liver failure]] | * [[Hepatic failure|Liver failure]] | ||
|- | |- | ||
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| align="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 | | align="center" style="background:#F5F5F5;" + |Clinical manifestation | ||
| align="left" style="background:#F5F5F5;" + | | | align="left" style="background:#F5F5F5;" + | | ||
* [[Seizure]] | * [[Seizure]] | ||
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| align="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 | | align="center" style="background:#F5F5F5;" + |Clinical manifestation | ||
| align=" | | 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> | ! 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> | ||
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| align="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 | | align="center" style="background:#F5F5F5;" + |Clinical manifestation | ||
| align=" | | 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> | ! 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> | ||
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| align="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 | | align="center" style="background:#F5F5F5;" + |Clinical manifestation | ||
| align=" | | 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> | ! 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> | ||
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| align="center" style="background:#F5F5F5;" + |− | | align="center" style="background:#F5F5F5;" + |− | ||
| align="center" style="background:#F5F5F5;" + |Blood [[cyanide]] concentration | | align="center" style="background:#F5F5F5;" + |Blood [[cyanide]] concentration | ||
| align=" | | align="left" style="background:#F5F5F5;" + | | ||
* Not applicable | |||
|- | |- | ||
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Category | ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Category | ||
| Line 420: | Line 425: | ||
! align="center" style="background:#4479BA; color: #FFFFFF;" + |BP | ! align="center" style="background:#4479BA; color: #FFFFFF;" + |BP | ||
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Dehydration | ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Dehydration | ||
! align="center" style="background:#4479BA; color: #FFFFFF;" + | | ! 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;" + |HCO<sub>3</sub><sup>−</sup> | ||
! align="center" style="background:#4479BA; color: #FFFFFF;" + |paCO<sub>2</sub> | ! align="center" style="background:#4479BA; color: #FFFFFF;" + |paCO<sub>2</sub> | ||
| Line 462: | Line 467: | ||
| 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;" + |↑ | ||
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| align="center" style="background:#F5F5F5;" + | + | | align="center" style="background:#F5F5F5;" + | + | ||
| align="center" style="background:#F5F5F5;" + |Clinical + [[hyperglycemia]] + [[ketosis]] | | align="center" style="background:#F5F5F5;" + |Clinical + [[hyperglycemia]] + [[ketosis]] | ||
| align=" | | 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> | |||
|- | |- | ||
! 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> | ! 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> | ||
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| align="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 | | align="center" style="background:#F5F5F5;" + |Clinical manifestation | ||
| align=" | | 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> | ||
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| align="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 + [[ketosis]] | | align="center" style="background:#F5F5F5;" + |Clinical manifestation + [[ketosis]] | ||
| align="left" style="background:#F5F5F5;" + | | | align="left" style="background:#F5F5F5;" + | | ||
* Chronic [[alcohol abuse]] | * Chronic [[alcohol abuse]] | ||
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| align="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 and lab finding | | align="center" style="background:#F5F5F5;" + |Clinical manifestation and lab finding | ||
| align=" | | 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> | ! 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> | ||
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| align="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 and lab finding | | align="center" style="background:#F5F5F5;" + |Clinical manifestation and lab finding | ||
| align=" | | 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> | ||
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| align="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 and lab finding | | align="center" style="background:#F5F5F5;" + |Clinical manifestation and lab finding | ||
| align=" | | align="left" style="background:#F5F5F5;" + | | ||
* Not applicable | |||
|- | |- | ||
| rowspan="5" align="center" style="background:#4479BA; color: #FFFFFF;" + |Renal | | rowspan="5" align="center" style="background:#4479BA; color: #FFFFFF;" + |Renal | ||
| Line 675: | Line 685: | ||
| align="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 and lab finding | | align="center" style="background:#F5F5F5;" + |Clinical manifestation and lab finding | ||
| align=" | | align="left" style="background:#F5F5F5;" + | | ||
* May lead to [[pericarditis]] | |||
|- | |- | ||
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Renal failure]]<ref name="KrautMadias2016">{{cite journal|last1=Kraut|first1=Jeffrey A.|last2=Madias|first2=Nicolaos E.|title=Metabolic Acidosis of CKD: An Update|journal=American Journal of Kidney Diseases|volume=67|issue=2|year=2016|pages=307–317|issn=02726386|doi=10.1053/j.ajkd.2015.08.028}}</ref> | ! colspan="2" align="center" style="background:#DCDCDC;" + |[[Renal failure]]<ref name="KrautMadias2016">{{cite journal|last1=Kraut|first1=Jeffrey A.|last2=Madias|first2=Nicolaos E.|title=Metabolic Acidosis of CKD: An Update|journal=American Journal of Kidney Diseases|volume=67|issue=2|year=2016|pages=307–317|issn=02726386|doi=10.1053/j.ajkd.2015.08.028}}</ref> | ||
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| align="center" style="background:#F5F5F5;" + | − | | align="center" style="background:#F5F5F5;" + | − | ||
| align="center" style="background:#F5F5F5;" + |[[Renal function tests|Renal function test]] | | align="center" style="background:#F5F5F5;" + |[[Renal function tests|Renal function test]] | ||
| align=" | | align="left" style="background:#F5F5F5;" + | | ||
* 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> | ! 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> | ||
| Line 742: | Line 754: | ||
| align="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 and lab finding | | align="center" style="background:#F5F5F5;" + |Clinical manifestation and lab finding | ||
| align="left" style="background:#F5F5F5;" + | | | align="left" style="background:#F5F5F5;" + | | ||
* Associated with [[Autoimmunity|autoimmune diseases]] | * Associated with [[Autoimmunity|autoimmune diseases]] | ||
| Line 777: | Line 789: | ||
| align="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 and lab finding | | align="center" style="background:#F5F5F5;" + |Clinical manifestation and lab finding | ||
| align=" | | align="left" style="background:#F5F5F5;" + | | ||
* Not applicable | |||
|- | |- | ||
! align="center" style="background:#DCDCDC;" + |Type IV | ! align="center" style="background:#DCDCDC;" + |Type IV | ||
| Line 810: | Line 823: | ||
| align="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 and lab finding | | align="center" style="background:#F5F5F5;" + |Clinical manifestation and lab finding | ||
| align="left" style="background:#F5F5F5;" + | | | align="left" style="background:#F5F5F5;" + | | ||
* [[Hypoaldosteronism]] | * [[Hypoaldosteronism]] | ||
| Line 826: | Line 839: | ||
! align="center" style="background:#4479BA; color: #FFFFFF;" + |BP | ! align="center" style="background:#4479BA; color: #FFFFFF;" + |BP | ||
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Dehydration | ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Dehydration | ||
! align="center" style="background:#4479BA; color: #FFFFFF;" + | | ! 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;" + |HCO<sub>3</sub><sup>−</sup> | ||
! align="center" style="background:#4479BA; color: #FFFFFF;" + |paCO<sub>2</sub> | ! align="center" style="background:#4479BA; color: #FFFFFF;" + |paCO<sub>2</sub> | ||
| Line 879: | Line 892: | ||
| align="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 + [[echocardiogram]] | | align="center" style="background:#F5F5F5;" + |Clinical manifestation+ [[echocardiogram]] | ||
| align="left" style="background:#F5F5F5;" + | | | align="left" style="background:#F5F5F5;" + | | ||
* [[Hypoalbuminemia]] | * [[Hypoalbuminemia]] | ||
| Line 914: | Line 927: | ||
| align="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 + [[ECG]] | | align="center" style="background:#F5F5F5;" + |Clinical manifestation + [[ECG]] | ||
| align=" | | align="left" style="background:#F5F5F5;" + | | ||
* Not applicable | |||
|- | |- | ||
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" + |GI | ! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" + |GI | ||
| Line 929: | Line 943: | ||
| align="center" style="background:#F5F5F5;" + |↓ | | align="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;" + |↓ | | align="center" style="background:#F5F5F5;" + |↓ | ||
| Line 949: | Line 963: | ||
| align="center" style="background:#F5F5F5;" + |− | | align="center" style="background:#F5F5F5;" + |− | ||
| align="center" style="background:#F5F5F5;" + |[[Stool examination|Stool exam]] | | align="center" style="background:#F5F5F5;" + |[[Stool examination|Stool exam]] | ||
| align=" | | 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> | ! 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> | ||
| Line 981: | Line 996: | ||
| align="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 | | align="center" style="background:#F5F5F5;" + |Clinical manifestation | ||
| align="left" style="background:#F5F5F5;" + | | | 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> | ! 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> | ||
| Line 1,016: | Line 1,032: | ||
| align="center" style="background:#F5F5F5;" + |[[Liver biopsy]] | | align="center" style="background:#F5F5F5;" + |[[Liver biopsy]] | ||
| align="left" style="background:#F5F5F5;" + | | | align="left" style="background:#F5F5F5;" + | | ||
* Not applicable | |||
|- | |- | ||
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Endocrine | ! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Endocrine | ||
| Line 1,049: | Line 1,066: | ||
| align="center" style="background:#F5F5F5;" + |− | | align="center" style="background:#F5F5F5;" + |− | ||
| align="center" style="background:#F5F5F5;" + |[[Parathyroid hormone|PTH]] level | | align="center" style="background:#F5F5F5;" + |[[Parathyroid hormone|PTH]] level | ||
| align=" | | 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> | ! 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> | ||
| Line 1,099: | Line 1,117: | ||
! align="center" style="background:#4479BA; color: #FFFFFF;" + |BP | ! align="center" style="background:#4479BA; color: #FFFFFF;" + |BP | ||
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Dehydration | ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Dehydration | ||
! align="center" style="background:#4479BA; color: #FFFFFF;" + | | ! 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;" + |HCO<sub>3</sub><sup>−</sup> | ||
! align="center" style="background:#4479BA; color: #FFFFFF;" + |paCO<sub>2</sub> | ! align="center" style="background:#4479BA; color: #FFFFFF;" + |paCO<sub>2</sub> | ||
| Line 1,123: | Line 1,141: | ||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
[[Category:Medicine]] | |||
[[Category:Nephrology]] | |||
[[Category:Up-To-Date]] | |||
Latest revision as of 22:43, 29 July 2020
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sadaf Sharfaei M.D.[2]
Overview
Metabolic acidosis is occured in different situations such as poisoning, ketoacidosis, renal, gastrointestinal, cardiac, endocrine, and systemic diseases.
Metabolic Acidosis Differential Diagnosis
Differential diagnosis of metabolic acidosis is as follow:[1][2][3][4]
To review differential diagnosis of high anion gap metabolic acidosis, click here.
To review differential diagnosis of high osmolar gap metabolic acidosis, click here.
To review differential diagnosis of metabolic acidosis and lactic acidosis, click here.
| Category | Disease | Mechanism | Clinical | Paraclinical | Gold standard diagnosis | Other findings | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Symptoms | Signs | Lab data | |||||||||||||||||||||||||||||||
| ABG | CBC | Chemistry | Renal | U/A | |||||||||||||||||||||||||||||
| ↑ acid production |
Loss of bicarbonate |
↓ renal acid excretion |
Fever | N/V | Diarrhea | Dyspnea | Toxic/ill | BP | Dehydration | Level of consciousness | HCO3− | paCO2 | O2 | WBC | Hb | BS | Cl− | K+ | Na+ | Ketones | Lactic acid | Serum AG[5] | Osmolar gap[6] | Bun | Cr | Urine pH | Urine AG | Urine ketone | |||||
| Toxin/Medication[7] | Alcohol poisoning[8][9] | + | − | − | − | + | − | − | + | ↓ ↑ | + | ↓ | ↓ | ↓ | ↓ | Nl | Nl | ↑ | ↑ | ↑ | Nl | + | ↑ | ↑ | ↑ | Nl or ↑ | Nl or ↑ | ↓ | + | + | Clinical manifestation |
| |
| + | − | − | − | + | − | − | + | ↓ | + | ↓ | ↓ | ↓ | ↓ | Nl | Nl | Nl | ↑ | ↑ | Nl | + | ↑ | Nl | ↑ | Nl | Nl or ↑ | ↓ | + | + | Clinical manifestation |
| |||
| Toluene toxicity[11] | + | − | + | − | + | − | − | + | ↓ | − | ↓ | ↓↓ | ↓ | Nl | Nl | Nl | Nl | Nl | ↓ | Nl | − | ↑ | Nl or ↑ | Nl | ↑ | ↑ | ↓ | − | + | Clinical manifestation |
| ||
| Salicylates overdose[12] | + | − | − | − | + | − | + | + | ↓ | + | ↓ | ↓ | ↓↓ | ↓ | Nl | Nl | Nl to ↓ | Nl | ↓ | Nl | − | ↑ | ↑ | ↑ | ↑ | ↑ | ↓ | − | − | Clinical and elevated serum salicylate level |
| ||
| Metformin[13] | + | − | − | − | + | − | − | + | ↓ | ± | Agitated | ↓ | ↓ | Nl | Nl to ↑ | ↓ | ↓ | Nl | Nl | Nl | Nl | ↑ | ↑ | ↑ | Nl or ↑ | Nl | ↓ | − | − | Clinical manifestation |
| ||
| Isoniazid[14] | + | − | − | − | + | − | − | + | ↑ | + | Agitated | ↓ | ↓ | Nl | Nl | ↓ | Nl | Nl | Nl | Nl | Nl | ↑ | ↑ | Nl | Nl or ↑ | Nl | ↓ | − | − | Clinical manifestation | |||
| Acetazolamide[15] | − | + | − | − | − | − | − | − | ↓ | + | Nl | ↓ | ↓ | Nl to ↓ | Nl | Nl | Nl | Nl | Nl | Nl | Nl | Nl | Nl | Nl | Nl or ↑ | Nl | ↓ | − | − | Clinical manifestation |
| ||
| Amphotericin B[16] | − | − | + | − | + | + | − | + | ↓ | + | ↓ | ↓ | ↓ | Nl to ↓ | Nl | Nl | Nl | Nl | Nl | Nl | Nl | Nl | Nl | Nl | ↑ | ↑ | ↓ | − | − | Clinical manifestation |
| ||
| Carbon monoxide poisoning[17] | + | − | + | − | ± | − | − | + | Nl | − | ↓↓ | ↓ | ↓ | Nl to ↓ | Nl | Nl | Nl | Nl | Nl | Nl | Nl | ↑ | ↑ | Nl | Nl | Nl | ↓ | − | − | Clinical manifestation |
| ||
| Cyanide poisoning[18] | + | − | − | − | + | − | − | + | ↓ | ± | ↓↓ | ↓ | ↓ | ↓ | Nl to ↑ | ↓ | Nl | Nl | Nl | Nl | Nl | ↑ | ↑ | Nl | Nl or ↑ | Nl | ↓ | − | − | Blood cyanide concentration |
| ||
| Category | Disease | ↑ acid production |
Loss of bicarbonate |
↓ renal acid excretion |
Fever | N/V | Diarrhea | Dyspnea | Toxic/ill | BP | Dehydration | Level of consciousness | HCO3− | paCO2 | O2 | WBC | Hb | BS | Cl− | K+ | Na+ | Ketones | Lactic acid | Serum AG | Osmolar gap | Bun | Cr | Urine pH | Urine AG | Urine ketone | Gold standard diagnosis | Other findings | |
| Ketoacidosis | Diabetic ketoacidosis[19] | + | − | − | + | + | + | + | + | ↓ | + | ↓ | ↓ | ↓ | Nl to ↓ | ↑ | Nl to ↑ | ↑↑ | Nl | ↑ | ↓ | ↑ | ↑ | ↑ | ↑ | Nl to ↑ | Nl | ↓ | + | + | Clinical + hyperglycemia + ketosis |
| |
| Starvation[20] | + | − | − | − | + | − | − | + | ↓ | + | ↓ | ↓ | ↓ | Nl | Nl | Nl | Nl to ↓ | Nl | ↓ | ↓ | ↑ | Nl | ↑ | Nl | Nl | Nl | Nl | + | − | Clinical manifestation |
| ||
| Alcoholic ketoacidosis (Ethanol)[21] | + | − | − | − | + | ± | − | + | ↓ ↑ | + | Agitated | ↓ | ↓ | ↓ | Nl to ↑ | Nl to ↑ | ↓ Nl ↑ | Nl | ↓ | ↓ | ↑↑ | ↑ | ↑ | ↑↑ | ↑ | Nl | ↓ | + | + | Clinical manifestation + ketosis |
| ||
| Systemic | Sepsis[22] | + | − | − | + | + | − | + | + | ↓ ↑ | + | ↓ | ↓ | ↓ | Nl to ↓ | ↑ | Nl | Nl | Nl | ↑ | ↓ | Nl | Nl to ↑ | Nl | Nl | ↑ | ↑ | Nl | − | − | Clinical manifestation and lab finding |
| |
| Ischemia[23] | + | − | − | − | + | − | + | + | ↓ | + | − | ↓ | ↓ ↑ | Nl to ↓ | Nl to ↑ | Nl | Nl | Nl | ↑ | ↓ | Nl | Nl to ↑ | Nl | Nl | Nl to ↑ | Nl to ↑ | Nl | − | − | Clinical manifestation and lab finding |
| ||
| Lactic acidosis[24] | + | − | − | ± | + | − | − | + | ↓ ↑ | ± | Agitated | ↓ | ↓ | ↓ | Nl to ↑ | ↓ | Nl | Nl | Nl | Nl | Nl | ↑ | ↑ | ↑ | Nl or ↑ | Nl | ↓ | − | − | Clinical manifestation and lab finding |
| ||
| Renal | Uremia[25] | − | − | + | + | + | − | − | + | ↓ ↑ | ± | ↓ | ↓ | ↓ | Nl to ↓ | ↑ | ↓ | Nl | Nl | ↑ | ↑ | Nl | Nl | ↑ | ↑ | ↑ | ↑ | ↓ | + | − | Clinical manifestation and lab finding |
| |
| Renal failure[26] | − | − | + | − | + | − | − | + | ↓ | + | ↓ | ↓ | ↓ | Nl to ↓ | ↑ | ↓ | Nl | ↑ | ↑ | ↓ | Nl | Nl | ↑ | ↑ | ↑ | ↑ | ↓ | − | − | Renal function test |
| ||
| Renal tubular acidosis[27] | Type I[28] | − | − | + | ± | ± | − | − | − | ↓ ↑ | − | − | ↓ | ↓ | Nl | Nl | Nl | Nl | ↑ | ↓ | ↓ | Nl | Nl | Nl | Nl | ↑ | ↑ | ↑ | + | − | Clinical manifestation and lab finding |
| |
| Type II | − | + | − | ± | ± | − | − | − | ↓ ↑ | − | − | ↓ | ↓ | Nl | Nl | Nl | Nl | ↑ | ↓ | Nl | Nl | Nl | Nl | Nl | Nl | Nl | Nl | − | − | Clinical manifestation and lab finding |
| ||
| Type IV | − | − | + | ± | ± | ± | − | − | ↓ | − | − | ↓ | ↓ | Nl | Nl | Nl | Nl | ↑ | ↑ | Nl | Nl | Nl | Nl | Nl | Nl | Nl | Nl | + | − | Clinical manifestation and lab finding | |||
| Category | Disease | ↑ acid production |
Loss of bicarbonate |
↓ renal acid excretion |
Fever | N/V | Diarrhea | Dyspnea | Toxic/ill | BP | Dehydration | Level of consciousness | HCO3− | paCO2 | O2 | WBC | Hb | BS | Cl− | K+ | Na+ | Ketones | Lactic acid | Serum AG | Osmolar gap | Bun | Cr | Urine pH | Urine AG | Urine ketone | Gold standard diagnosis | Other findings | |
| Heart | Heart failure[29] | + | + | − | − | ± | − | + | + | ↓ ↑ | + | − | ↓ | ↓ ↑ | ↓ | Nl | Nl | Nl | Nl | ↓ | ↓ | Nl | Nl | Nl | Nl | Nl to ↑ | Nl to ↑ | Nl | − | − | Clinical manifestation+ echocardiogram |
| |
| Myocardial infarction[30] | + | − | − | − | + | − | + | + | ↓ ↑ | − | ↓ | ↓ | ↓ ↑ | Nl to ↓ | Nl to ↑ | Nl | Nl | Nl | ↑ | ↓ | Nl | ↑ | Nl | Nl | Nl to ↑ | Nl to ↑ | Nl | − | − | Clinical manifestation + ECG |
| ||
| GI | Diarrhea[31] | − | + | − | ± | + | + | − | + | ↓ | + | May be lethargic | ↓ | ↓ | Nl | Nl | ↓ | ↓ | ↑ | ↑ | Nl | Nl | Nl | Nl | Nl | ↑ | Nl | Nl | − | − | Stool exam |
| |
| Hyperalimentation[32] | + | + | − | − | − | + | − | − | Nl | − | − | ↓ | ↓ | Nl | Nl | ↓ | Nl | ↑ | ↑ | Nl | Nl | Nl | Nl | Nl | Nl | Nl | Nl | − | − | Clinical manifestation |
| ||
| Liver failure[33] | − | + | − | − | + | + | − | + | ↓ | + | Confused | ↓ | ↓ | Nl | Nl | ↓ | ↓ ↑ | ↑ | ↓ | ↓ | Nl | Nl | Nl | Nl | Nl | Nl | Nl | − | − | Liver biopsy |
| ||
| Endocrine | Hyperparathyroidism[34] | − | + | + | − | + | − | − | − | Nl | + | Confused | ↓ | ↓ | Nl | Nl | Nl | Nl | Nl | Nl | Nl | Nl | Nl | Nl | Nl | Nl to ↑ | Nl | Nl | − | − | PTH level |
| |
| Addison's disease[35] | − | + | − | − | + | + | − | − | ↓ | + | Irritable | ↓ | ↓ | Nl | Nl | Nl | ↓ | Nl | ↑ | ↓ | Nl | Nl | Nl | Nl | Nl | Nl | Nl | − | − | Hormone level | |||
| Category | Disease | ↑ acid production |
Loss of bicarbonate |
↓ renal acid excretion |
Fever | N/V | Diarrhea | Dyspnea | Toxic/ill | BP | Dehydration | Level of consciousness | HCO3− | paCO2 | O2 | WBC | Hb | BS | Cl− | K+ | Na+ | Ketones | Lactic acid | Serum AG | Osmolar gap | Bun | Cr | Urine pH | Urine AG | Urine ketone | Gold standard diagnosis | Other findings | |
References
- ↑ Lim S (2007). "Metabolic acidosis". Acta Med Indones. 39 (3): 145–50. PMID 17936961.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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/
- ↑ 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.
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|title=(help) - ↑ Ganesh K, Sharma RN, Varghese J, Pillai MG (2016). "A profile of metabolic acidosis in patients with sepsis in an Intensive Care Unit setting". Int J Crit Illn Inj Sci. 6 (4): 178–181. doi:10.4103/2229-5151.195417. PMC 5225760. PMID 28149822.
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