metabolic acidosis

Question 1

what are the causes of a normal anion gap- hyperchloraemic metabolic acidosis

Answer 1

GI bicarbonate loss
- prolonged diarrhoea-> hypoK
- ureterosigmoidostomy
- fistula

renal tubular acidosis
drugs eg acetazolamide
ammonium chloride injection
addison’s disease

Question 2

what are the causes of a raised anion gap metabolic acidosis?

Answer 2

lactate
lactic acidosis type A
- shock
- sepsis
- hypoxia
- burns
lactic acidosis type B
-metformin

ketones
- DKA
- alcohol

urate
- renal failure

acid poisoning
- salicylates
- methanol
- 5-oxoproline- chronic paracetamol use

Question 3

note on causes of metabolic acidosis causes

Answer 3

diarrhoea causes normal anion gap metabolic acidosis - loss of base/bicarb due to GI loss

vomiting causes hypochloraemic metabolic ALKALOSIS- due to loss of H+ in vomit + loss of chloride

addisons- hypoNa, hyperK, normal anion gap met acidosis. loss of bicarb due to mineralocorticoid deficiency

sepsis- high anion gap metabolic acidosis (8-14). due to production of lactic acid due to inadequate tissue perfusion