Metabolic acidosis resident survival guide

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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]

Definition

Metabolic acidosis is a state in which the blood pH is low (less than 7.35) due to increased production of H⁺ by the body or the inability of the body to form bicarbonate (HCO₃^-) in the kidney.

Causes

Life Threatening Causes

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

Common Causes

Normal Anion Gap Metabolic 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- Hyperailmentation

• A- Addison's disease, acetazolamide, ammonium chloride

• M- Miscellaneous (chloridorrhea, amphotericin B, toluene - toluene causes high anion gap metabolic acidosis followed by normal anion gap metabolic acidosis

Increased/High Anion Gap Metabolic Acidosis

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

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