Metabolic acidosis causes

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ogheneochuko Ajari, MB.BS, MS [2]

Overview

Metabolic acidosis occurs when the body produces too much acid, or when the kidneys are not removing enough acid from the body. There are several types of metabolic acidosis. The main causes are best grouped by their influence on the anion gap.

Causes

Life Threatening Causes

• Diabetic ketoacidosis
• Ethylene Glycol poisoning
• Lactic acidosis
• Methanol

Common Causes

Low Anion Gap

• Hypoalbuminemia
• Multiple myeloma

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 - toluene causes high anion gap metabolic acidosis followed by normal anion gap metabolic acidosis).

High Anion Gap

The mnemonic "MUDPILES" is used to remember the causes of a high anion gap.

• M - Methanol/Metformin
  
• U - Uremia
  
• D - Diabetic ketoacidosis
  
• P - Paraldehyde/Propylene glycol
  
• I - Infection/Ischemia/Isoniazid
  
• L - Lactate
  
• E - Ethylene glycol/Ethanol
  
• S - Salicylates/Starvation

Causes by Organ System

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

Causes in Alphabetical Order

1,2-Dibromoethane 17- beta-hydroxysteroid dehydrogenase deficiency 3-hydroxyacyl-coenzyme A dehydrogenase deficiency 3-Hydroxyisobutyric aciduria 3-Methylcrotonyl-CoA carboxylase deficiency 3-methylglutaconic aciduria 4-Aminopyridine Abacavir Acetazolamide Acute liver failure Acute renal failure Adrenal cortex insufficiency Aldicarb Alsing syndrome Amitriptyline Amlodipine Ammonium bifluoride Ammonium chloride Amoxapine Amphotericin B Analgesic nephropathy syndrome Aortic arch interruption Aristolochic acid Aspirin Bacterial overgrowth of small intestine Bicarbonate deficit Biliary fistula Biotinidase deficiency Boichis syndrome Borates Bromophos Carbaryl Chloralose Chlorfenvinphos Chlorpyrifos Cholestyramine Chronic interstitial nephritis Chronic renal failure Cleistanthus Collinus Clomipramine Clove Cocaine Coenzyme Q10 deficiency Compensatory 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 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 GI HCO3- loss Glucocorticoid resistance Glucose transporter type 1 deficiency Glutaric aciduria Glutathione synthase 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 Imazapyr Imipramine Intestinal fistulas Intestinal ischaemia Iron compounds Isoniazid Isovaleric acidaemia Isradipine Ketoacidosis Lactic acidosis Lactose intolerance Leigh syndrome Lightwood-Albright syndrome Lipoid congenital adrenal hyperplasia Long chain hydroxyacyl-CoA dehydrogenase deficiency Lowe Syndrome Lutz-Richner-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, Amish type Mitochondrial acetoacetyl-CoA thiolase deficiency 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 Osteopetrosis with renal tubular acidosis Pancreatic fistula Paracetamol Parathion Phenformin Phenol Phosdrin Phosphoglucomutase deficiency Polyethylene glycol Profenofos Propionic Acidemia Propionyl-CoA carboxylase deficiency Propoxur Propylene glycol Protriptyline Pseudohypoaldosteronism Pyrimidifen Pyruvate carboxylase deficiency Pyruvate dehydrogenase deficiency Renal HCO3- loss Renal tubular acidosis Reye's Syndrome Salicylate poisoning Senior-Loken Syndrome Shock Short bowel syndrome Short chain acyl-CoA dehydrogenase deficiency Starvation Stavudine Strychnine Succinyl-CoA acetoacetate transferase deficiency Succinyl-CoA synthetase deficiency Terbufos Tetraethyl Pyrophosphate Toluene Toxic mushrooms Triethylene Glycol Trimipramine Tungsten Ureterosigmoidostomy Ureteral diversion VIPoma Vitamin B12-responsive methylmalonic acidemia