View source for Metabolic acidosis causes

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{{Metabolic acidosis}}
{{CMG}}; {{AE}} {{Ochuko}}

==Overview==
Metabolic acidosis is a state in which the blood pH is low (less than 7.35) due to an increased blood concentration of H+.

==Causes==
===Life Threatening Causes===
*[[Diabetic ketoacidosis]]
*[[Ethylene Glycol poisoning]]
*[[Lactic acidosis]]
*[[Methanol]]

===Common Causes===
====Normal Anion Gap (Hyperchloremic Acidosis)====
The mnemonic for the most common causes of a normal-anion gap metabolic acidosis is "DURHAM."
* '''D'''- [[Diarrhea]]

* '''U'''- [[Ureteral diversion]]

* '''R'''- [[Renal tubular acidosis]]

* '''H'''- [[Hyperalimentation]]

* '''A'''- [[Addison's disease]], [[acetazolamide]], [[ammonium chloride]]

* '''M'''- Miscellaneous ([[congenital chloride diarrhea]], [[amphotericin B]], [[toluene]]

====High Anion Gap====
The mnemonic "MUDPILES" is used to remember the causes of a high anion gap.
* '''M''' - [[Methanol]]/[[Metformin]]<br />
* '''U''' - [[Uremia]]<br />
* '''D''' - [[Diabetic ketoacidosis]]<br />
* '''P''' - [[Paraldehyde]]/[[Propylene glycol]]<br />
* '''I''' - [[Infection]]/[[Ischemia]]/[[Isoniazid]]<br />
* '''L''' - [[Lactate]]<br />
* '''E''' - [[Ethylene glycol]]/[[Ethanol]]<br />
* '''S''' - [[Salicylates]]/[[Starvation]]

=== Causes by Organ System ===

{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Aortic arch interruption]], [[Fanconi-Albertini-Zellweger syndrome]], [[hypoplastic left heart syndrome]], [[shock]]
|-
|-bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
|bgcolor="Beige"| [[aldicarb]], [[4-aminopyridine]], [[ammonium bifluoride]], [[ammonium chloride]], [[aristolochic acid ]], [[borates]], [[bromophos]], [[carbaryl]], [[chloralose]], [[chlorfenvinphos]], [[chlorpyrifos]], cleistanthus collinus, [[clove]], [[coumaphos]], [[cyanides]], [[demeton-S-methyl]], [[diazinon]], [[1,2-Dibromoethane]], [[dichlorvos]], [[dicrotophos]], [[dinitrophenol]], [[dioxathion]], [[disulfoton]], [[ethanol]], [[ethion]], [[ethylene glycol]], [[fensulfothion]], [[fenthion]], [[glycol ether]], [[glyphosate]], imazapyr, [[iron|iron compounds]], [[iobenguane I 123]],[[malathion]], margosa oil, [[metaldehyde]], [[methanol]], [[methidathion]], [[methiocarb]], [[methomyl]], [[monochloroacetate]], [[parathion]], [[phenol]], [[phosdrin]], [[polyethylene glycol ]], [[profenofos]], [[propoxur]], [[propylene glycol]], pyrimidifen, [[salicylate poisoning]], [[strychnine]], [[terbufos]], [[pyrophosphate|tetraethyl pyrophosphate]], [[toluene]], [[toxic mushrooms ]], [[triethylene glycol]], [[tungsten]]
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| [[Abacavir]], [[Acetaminophen and Oxycodone]], [[acetazolamide]], [[amitriptyline]], [[amlodipine]], [[amoxapine]], [[amphotericin B]], [[aspirin]], [[cholestyramine]], [[clomipramine]], [[clove]], [[cocaine]], [[desipramine]], [[didanosine]], [[doxepin]], [[emtricitabine]], [[felodipine ]], [[formoterol]], [[imipramine]], [[isoniazid]], [[isradipine]], [[Ixabepilone]], [[Mafenide]], [[malignant hyperpyrexia]], [[malignant hyperthermia]], [[metformin]], [[neuroleptic malignant syndrome]], [[nifedipine]], [[nimodipine]], [[nitroprusside]], [[nortriptyline]], [[Oxaliplatin]], [[paracetamol]], [[phenformin]], [[Potassium chloride]], [[protriptyline]], [[Reye's syndrome]], [[salicylate poisoning]], [[stavudine]], [[topiramate]], [[trimipramine]]
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|- 
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| [[Adrenal cortex insufficiency]], [[17- beta-hydroxysteroid dehydrogenase deficiency]], [[diabetes]], [[diabetic ketoacidosis]], [[glucocorticoid resistance]], [[hyperosmolar non-ketotic diabetic coma]], [[hypoaldosteronism]], [[lipoid congenital adrenal hyperplasia]], [[pseudohypoaldosteronism]], [[VIPoma]]
|- 
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| [[Acute liver failure]], [[bacterial overgrowth of small intestine]], [[biliary fistula]], [[congenital chloride diarrhea]], [[diarrhea]], [[duodenal atresia]], [[metabolic acidosis|GI HCO3- loss]], [[hepatic failure]], [[fistula|intestinal fistulas]], [[intestinal ischaemia]], [[lactose intolerance]], [[necrotizing enterocolitis]], [[pancreatic fistula]], [[VIPoma]]
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"|[[17- beta-hydroxysteroid dehydrogenase deficiency]], [[biotinidase deficiency]], [[coenzyme Q10|coenzyme Q10 deficiency]], [[congenital chloride diarrhea]], [[cystinosis]], [[dihydrolipoamide|dihydrolipoamide dehydrogenase deficiency]], [[fructose-1, 6-diphosphatase deficiency]], [[ethylmalonic encephalopathy]], [[Fanconi-Albertini-Zellweger syndrome]], [[fructose-1-phosphate aldolase deficiency]], [[galactosemia]], [[GLUT1|glucose transporter type 1 deficiency]], [[glutaric aciduria]], [[glutathione synthetase deficiency]], [[glycerol kinase deficiency]], [[glycogenosis]], [[GRACILE syndrome]], [[Hawkinsinuria]], hepatocerebral form of mitochondrial DNA depletion syndrome, [[HMG-CoA lyase deficiency]], [[holocarboxylase synthase deficiency]], [[3-hydroxyacyl-coenzyme A dehydrogenase deficiency]], [[3 hydroxyisobutyric aciduria]], [[isovaleric acidaemia]], [[lipoid congenital adrenal hyperplasia]], [[long chain hydroxyacyl-CoA dehydrogenase deficiency]], [[Lowe syndrome]], [[Lutz-Richner and Landolt syndrome]], [[malignant hyperpyrexia]], [[malignant hyperthermia]], [[malonyl-CoA decarboxylase deficiency]], [[maple syrup urine disease]], [[medium chain acyl-CoA dehydrogenase deficiency]], [[medullary cystic kidney disease]], [[MELAS]], [[MERRF]], [[3-methylcrotonyl-CoA carboxylase deficiency]], [[3-methylglutaconic aciduria]], [[methylmalonic acidemia]], [[microcephaly|microcephaly, Amish type]], [[mitochondrial acetoacetyl-CoA thiolase deficiency]], [[DARS (gene)|mitochondrial aspartyl-tRNA synthetase  deficiency]], [[molybdenum cofactor deficiency]], myopathy with deficiency of succinate dehydrogenase and aconitase, [[nephronophthisis]], [[carbonic anhydrase II|osteopetrosis with renal tubular acidosis]], [[phosphoglucomutase|phosphoglucomutase deficiency]], [[propionic acidemia]], [[propionyl-CoA carboxylase deficiency]], [[pseudohypoaldosteronism]], [[pyruvate carboxylase deficiency]], [[pyruvate dehydrogenase deficiency]], [[Senior-Loken syndrome]], [[short-chain acyl-coenzyme A dehydrogenase deficiency]], succinyl-CoA acetoacetate transferase deficiency, [[succinyl coenzyme A synthetase|succinyl-CoA synthetase deficiency]], [[methylmalonic acidemia|vitamin B12-responsive methylmalonic acidemia]]
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| [[Myeloma]]
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| [[Hyperalimentation]], [[malignant hyperpyrexia]], [[malignant hyperthermia]], [[Reye's syndrome]], [[short bowel syndrome]], [[ureteral diversion]], [[ureterosigmoidostomy]]
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
|bgcolor="Beige"| Myopathy with deficiency of succinate dehydrogenase and aconitase, [[carbonic anhydrase II|osteopetrosis with renal tubular acidosis]]
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| [[Leigh syndrome]], [[Lowe Syndrome]], [[microcephaly|microcephaly, Amish type]]
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
|bgcolor="Beige"| [[17- beta-hydroxysteroid dehydrogenase deficiency]], [[biotinidase deficiency]], [[coenzyme Q10|coenzyme Q10 deficiency]], [[cystinosis]], [[diabetic ketoacidosis]], [[dihydrolipoamide|dihydrolipoamide dehydrogenase deficiency]], [[fructose-1, 6-diphosphatase deficiency]], [[ethylmalonic encephalopathy]], [[Fanconi-Albertini-Zellweger syndrome]], [[fructose-1-phosphate aldolase deficiency]], [[galactosemia]], [[glutaric aciduria]], [[glutathione synthetase deficiency]], [[glycerol kinase deficiency]], [[glycogenosis]], [[Hawkinsinuria]], [[HMG-CoA lyase deficiency]], [[holocarboxylase synthase deficiency]], [[3-hydroxyacyl-coenzyme A dehydrogenase deficiency]], [[3 hydroxyisobutyric aciduria]], [[Hyperkalaemia]], [[hyperosmolar non-ketotic diabetic coma]], [[hypoalbuminism]], [[isovaleric acidaemia]], [[ketoacidosis]], [[lactic acidosis]], [[Leigh syndrome]], [[long chain hydroxyacyl-CoA dehydrogenase deficiency]], [[malonyl-CoA decarboxylase deficiency]], [[maple syrup urine disease]], [[medium chain acyl-CoA dehydrogenase deficiency]], [[3-methylcrotonyl-CoA carboxylase deficiency]], [[3-methylglutaconic aciduria]], [[methylmalonic acidemia]], [[mitochondrial acetoacetyl-CoA thiolase deficiency]], [[molybdenum cofactor deficiency]], myopathy with deficiency of succinate dehydrogenase and aconitase, [[organic acidemia]], [[phosphoglucomutase|phosphoglucomutase deficiency]], [[propionic acidemia]], [[propionyl-CoA carboxylase deficiency]], [[pyruvate carboxylase deficiency]], [[pyruvate dehydrogenase deficiency]], [[short-chain acyl-coenzyme A dehydrogenase deficiency]], succinyl-CoA acetoacetate transferase deficiency, [[succinyl coenzyme A synthetase|succinyl-CoA synthetase deficiency]], [[methylmalonic acidemia|vitamin B12-responsive methylmalonic acidemia]]
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| [[Myeloma]]
|-
|-bgcolor="LightSteelBlue"
| '''Opthalmologic'''
|bgcolor="Beige"| [[Lowe syndrome]], [[Senior-Loken syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
|bgcolor="Beige"| [[Abacavir]], [[acetazolamide]], [[amitriptyline]], [[amlodipine]], [[amoxapine]], [[amphotericin B]], [[aspirin]], [[cholestyramine]], [[clomipramine]], [[clove]], [[cocaine]], [[desipramine]], [[didanosine]], [[doxepin]], [[emtricitabine]], [[felodipine ]], [[imipramine]], [[isoniazid]], [[isradipine]], [[malignant hyperpyrexia]], [[malignant hyperthermia]], [[metformin]], [[neuroleptic malignant syndrome]], [[nifedipine]], [[nimodipine]], [[nitroprusside]], [[nortriptyline]], [[paracetamol]], [[phenformin]], [[protriptyline]], [[Reye's syndrome]], [[salicylate poisoning]], [[stavudine]], [[trimipramine]]
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
|bgcolor="Beige"| [[Acute renal failure]], [[analgesic nephropathy syndrome]], [[interstitial nephritis|chronic interstitial nephritis]], [[chronic renal failure]], [[respiratory alkalosis|compensation in primary respiratory alkalosis]], [[hypoaldosteronism]], [[Lightwood Albright syndrome]], [[Lowe syndrome]], [[medullary cystic kidney disease]], [[nephronophthisis]], [[carbonic anhydrase II|osteopetrosis with renal tubular acidosis]], [[metabolic acidosis|renal HCO3- loss]], [[renal tubular acidosis]], [[Senior-Loken syndrome]], [[Ureteral diversion]]
|-
|-bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| [[17- beta-hydroxysteroid dehydrogenase deficiency]]
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| [[Ureteral diversion]]
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| Cuffed blood sample, [[near-drowning]], [[starvation]]
|-
|}

=== Causes in Alphabetical Order ===

{{MultiCol}}
*[[1,2-Dibromoethane]]
*[[3 hydroxyisobutyric aciduria]]
*[[3-hydroxyacyl-coenzyme A dehydrogenase deficiency]]
*[[3-methylcrotonyl-CoA carboxylase deficiency]]
*[[3-methylglutaconic aciduria]]
*[[4-aminopyridine]]
*[[17- beta-hydroxysteroid dehydrogenase deficiency]]
*[[Abacavir]]
*[[Acetazolamide]]
*[[Acute liver failure]]
*[[Acute renal failure]]
*[[Adrenal cortex insufficiency]]
*[[Aldicarb]]
*[[Amitriptyline]]
*[[Amlodipine]]
*[[Ammonium bifluoride]]
*[[Ammonium chloride]]
*[[Amoxapine]]
*[[Amphotericin B]]
*[[Analgesic nephropathy syndrome]]
*[[Aortic arch interruption]]
*[[Aristolochic acid ]]
*[[Aspirin]]
*[[Bacterial overgrowth of small intestine]]
*[[Biliary fistula]]
*[[Biotinidase deficiency]]
*[[Borates]]
*[[Bromophos]]
*[[Carbaryl]]
*[[Chloralose]]
*[[Chlorfenvinphos]]
*[[Chlorpyrifos]]
*[[Cholestyramine]]
*[[interstitial nephritis|Chronic interstitial nephritis]]
*[[Chronic renal failure]]
*Cleistanthus collinus
*[[Clomipramine]]
*[[Clove]]
*[[Cocaine]]
*[[coenzyme Q10|Coenzyme Q10 deficiency]]
*[[respiratory alkalosis|Compensation in primary respiratory alkalosis]]
*[[Congenital chloride diarrhea]]
*[[Coumaphos]]
*Cuffed blood sample
*[[Cyanides]]
*[[Cystinosis]]
*[[Demeton-S-methyl]]
*[[Desipramine]]
*[[Diabetes]]
*[[Diabetic ketoacidosis]]
*[[Diarrhea]]
*[[Diazinon]]
*[[Dichlorvos]]
*[[Dicrotophos]]
*[[Didanosine]]
*[[Dihydrolipoamide|Dihydrolipoamide dehydrogenase deficiency]]
*[[Dinitrophenol]]
*[[Dioxathion]]
*[[Disulfoton]]
*[[Doxepin]]
*[[Duodenal atresia]]
*[[Emtricitabine]]
*[[Ethanol]]
*[[Ethion]]
*[[Ethylene glycol]]
*[[Ethylmalonic encephalopathy]]
*[[Fanconi-Albertini-Zellweger syndrome]]
*[[Felodipine ]]
*[[Fensulfothion]]
*[[Fenthion]]
*[[Fructose-1, 6-diphosphatase deficiency]]
*[[Fructose-1-phosphate aldolase deficiency]]
*[[Galactosemia]]
*[[metabolic acidosis|GI HCO3- loss]]
*[[Glucocorticoid resistance]]
*[[GLUT1|Glucose transporter type 1 deficiency]]
*[[Glutaric aciduria]]
*[[Glutathione synthetase deficiency]]
*[[Glycerol kinase deficiency]]
*[[Glycogenosis]]
*[[Glycol Ether]]
*[[Glyphosate]]
*[[GRACILE syndrome]]
*[[Hawkinsinuria]]
*[[Hepatic failure]]
*Hepatocerebral form of mitochondrial DNA depletion syndrome
*[[HMG-CoA lyase deficiency]]
*[[Holocarboxylase synthase deficiency]]
*[[Hyperalimentation]]
*[[Hyperkalaemia]]
*[[Hyperosmolar non-ketotic diabetic coma]]
*[[Hypoalbuminism]]
*[[Hypoaldosteronism]]
*[[Hypoplastic left heart syndrome]]
{{ColBreak}}
*Imazapyr
*[[Imipramine]]
*[[fistula|Intestinal fistulas]]
*[[Intestinal ischaemia]]
*[[iron|Iron compounds]]
*[[Isoniazid]]
*[[Isovaleric acidaemia]]
*[[Isradipine]]
*[[Ixabepilone]]
*[[Ketoacidosis]]
*[[Lactic acidosis]]
*[[Lactose intolerance]]
*[[Leigh syndrome]]
*[[Lightwood Albright syndrome]]
*[[Lipoid congenital adrenal hyperplasia]]
*[[Long chain hydroxyacyl-CoA dehydrogenase deficiency]]
*[[Lowe Syndrome]]
*[[Lutz-Richner and Landolt syndrome]]
*[[Malathion]]
*[[Malignant hyperpyrexia]]
*[[Malignant hyperthermia]]
*[[Malonyl-CoA decarboxylase deficiency]]
*[[Maple syrup urine disease]]
*Margosa oil
*[[Medium chain acyl-CoA dehydrogenase deficiency]]
*[[Medullary cystic kidney disease]]
*[[MELAS]]
*[[MERRF]]
*[[Metaldehyde]]
*[[Metformin]]
*[[Methanol]]
*[[Methidathion]]
*[[Methiocarb]]
*[[Methomyl]]
*[[Methylmalonic acidemia]]
*[[microcephaly|Microcephaly, Amish type]]
*[[Mitochondrial acetoacetyl-CoA thiolase deficiency]]
*[[DARS (gene)|Mitochondrial aspartyl-tRNA synthetase deficiency]]
*[[Molybdenum cofactor deficiency]]
*[[Monochloroacetate]]
*[[Myeloma]]
*Myopathy with deficiency of succinate dehydrogenase and aconitase
*[[Near-drowning]]
*[[Necrotizing enterocolitis]]
*[[Nephronophthisis]]
*[[Neuroleptic malignant syndrome]]
*[[Nifedipine]]
*[[Nimodipine]]
*[[Nitroprusside]]
*[[Nortriptyline]]
*[[Organic acidemia]]
*[[carbonic anhydrase II|Osteopetrosis with renal tubular acidosis]]
*[[Pancreatic fistula]]
*[[Paracetamol]]
*[[Parathion]]
*[[Phenformin]]
*[[Phenol]]
*[[Phosdrin]]
*[[phosphoglucomutase|Phosphoglucomutase deficiency]]
*[[Polyethylene glycol ]]
*[[Profenofos]]
*[[Propionic acidemia]]
*[[Propionyl-CoA carboxylase deficiency]]
*[[Propoxur]]
*[[Propylene glycol]]
*[[Protriptyline]]
*[[Pseudohypoaldosteronism]]
*Pyrimidifen
*[[Pyruvate carboxylase deficiency]]
*[[Pyruvate dehydrogenase deficiency]]
*[[metabolic acidosis|Renal HCO3- loss]]
*[[Renal tubular acidosis]]
*[[Reye's syndrome]]
*[[Salicylate poisoning]]
*[[Senior-Loken syndrome]]
*[[Shock]]
*[[Short bowel syndrome]]
*[[Short-chain acyl-coenzyme A dehydrogenase deficiency]]
*[[Starvation]]
*[[Stavudine]]
*[[Strychnine]]
*Succinyl-CoA acetoacetate transferase deficiency
*[[Succinyl coenzyme A synthetase|Succinyl-CoA synthetase deficiency]]
*[[Terbufos]]
*[[pyrophosphate|Tetraethyl pyrophosphate]]
*[[Toluene]]
*[[Toxic mushrooms ]]
*[[Triethylene glycol]]
*[[Trimipramine]]
*[[Tungsten]]
*[[Ureteral diversion]]
*[[Ureterosigmoidostomy]]
*[[VIPoma]]
*[[methylmalonic acidemia|Vitamin B12-responsive methylmalonic acidemia]]
{{EndMultiCol}}

==References==
{{Reflist|2}}

[[Category:Electrolyte disturbance]]
[[Category:Inborn errors of metabolism]]
[[Category:Medical tests]]
[[Category:Laboratory Test]]
[[Category:Nephrology]]
[[Category:Intensive care medicine]]
[[Category:Emergency medicine]]

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