Metabolic acidosis differentials
Normal anion gap metab acidosis
When concentration of Cl ↑ to replace HCO3
ABCD
- Addison's/Adrenal insufficiency
- Bicarb loss - GI or renal
- diarrhoea, vomiting, ileostomy
- Chloride excess
- Diuretics (acetazolamide)
HARDUPS
- H: H+ secretion failure → renal tubular acidosis
- A: acetazolamide; Addison's
- R: renal tubular acidosis type 2
- D: diarrhoea - GI loss of HCO3
- U: uretopelvic fistula
- P: post-hypocapnia
- S: spironolactone
High anion gap metab acidosis HAGMA
When concentration of an unmeasured anion increases to replace HCO3 or impaired H excretion
often ↑ acid
MUDPILERS
- M: Methanol
- U: uraemia
- D: Diabetic ketoacidosis
- P: paracetamol, propylene glycol, paraldehyde
- I: infection, iron, isoniazid, inborn errors of metabolism (pyroglytamic acidosis)
- L: lactic acidosis (shock, hypoxia, drugs)
- E: ethylene glycol, ethanol
- R: rhabdomyolysis
- S: salicylate
- Carbon monoxide, cyanide
- alcoholic/starvation ketoacidosis
Or see:
G glycols (ethylene glycol & propylene glycol)
O oxoproline, a metabolite of paracetamol
L L-lactate, the chemical responsible for lactic acidosis
D D-lactate
M methanol
A aspirin
R renal failure
K ketoacidosis, ketones generated from starvation, alcohol, and diabetic ketoacidosis