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Metabolic Acidosis
By James L. Lewis, III, MD
Metabolic acidosis is primary reduction in HCO3−, typically with compensatory reduction in Pco2; pH may be markedly low or slightly subnormal. Metabolic acidoses are categorized as high or normal anion gap based on the presence or absence of unmeasured anions in serum. Causes include accumulation of ketones and lactic acid, renal failure, and drug or toxin ingestion (high anion gap) and GI or renal HCO3− loss (normal anion gap). Symptoms and signs in severe cases include nausea and vomiting, lethargy, and hyperpnea. Diagnosis is clinical and with ABG and serum electrolyte measurement. The cause is treated; IV NaHCO3 may be indicated when pH is very low.
Etiology
Symptoms and Signs
Diagnosis
ABG and serum electrolytes
Anion gap and delta gap calculated
Winter's formula for calculating compensatory changes
Testing for cause