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Approach to Metabolic Acidosis

Metabolic acidosis is a significant electrolyte disease defined by an acid-base imbalance in the body. The three main root causes of metabolic acidosis are increased acid production, bicarbonate loss, and a decreased ability of the kidneys to drain excess acids.

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Approach to Metabolic Acidosis

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  1. Approach to Metabolic Acidosis

  2. Metabolic acidosis is an acid-base disorder characterized by a decrease in serum pH that results from either a primary decrease in plasma bicarbonate concentration ([HCO3-]) or an increase in hydrogen ion concentration ([H+])

  3. A primary metabolic acidosis is a pathophysiologic state characterized by an arterial pH of less than 7.35 in the absence of an elevated PaCO2

  4. The kidneys are responsible for reclaiming filtered bicarbonate (HCO3-) and eliminating the daily acid load generated from nitrogen (protein) metabolism

  5. Anion gap To achieve electrochemical balance, ionic elements in the extracellular fluid must equal a net charge of zero. Therefore, the number of negatively charged ions (anions) should equal the number of positively charged ions (cations). Anion Gap = (Sodium) – (Chloride + Bicarbonate)

  6. Practically, a metabolic acidosis is divided into processes that are associated with a normal anion gap (8-12 mEq/L) or an elevated anion gap (>12 mEq/L)

  7. A normal anion gap metabolic acidosis involves no gain of unmeasured anions; however, because of the need for electrical neutrality, serum chloride replaces the depleted bicarbonate, and hyperchloremia develops. In contrast, an elevated anion gap metabolic acidosis is caused when extra unmeasured anions are added to the blood.

  8. Frequent causes of an elevated anion gap metabolic acidosis are represented by the mnemonic

  9. Causes of Normal anion gap metabolic acidosis can be represented by the mnemonic

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