Acidosis

• Metabolic acidosis
  • Anion gap acidosis (mnemonic: GOLDMARK or CAT MUDPILES)
    • Diabetic ketoacidosis (DKA)
    • Alcoholic ketoacidosis
    • Starvation ketoacidosis
    • Lactic acidosis
      • Metformin-associated lactic acidosis
      • Type A lactic acidosis (tissue hypoperfusion: shock, sepsis, mesenteric ischemia, cardiac arrest, seizures, carbon monoxide)
      • Type B lactic acidosis (impaired metabolism: liver failure, malignancy, medications, thiamine deficiency)
    • Toxic alcohols
      • Methanol
      • Ethylene glycol
    • Salicylate toxicity
    • Uremia / Renal failure
    • Pyroglutamic acidosis (5-oxoprolinemia; associated with chronic acetaminophen use, malnutrition, sepsis)
    • Iron
    • Isoniazid
    • Cyanide
    • D-lactic acidosis (short bowel syndrome)
    • Toluene (initially anion gap; may convert to non-anion gap)
  • Non anion gap acidosis (mnemonic: HARDUPS or USEDCARP)
    • Renal tubular acidosis
      • Type 1 (Distal) RTA
      • Type 2 (Proximal) RTA
      • Type 4 (Hypoaldosteronism) RTA
    • Diarrhea (most common cause of NAGMA)
    • Hyperchloremic acidosis (iatrogenic — excessive NS resuscitation)
    • Ureteral diversion (ileal conduit, ureterosigmoidostomy)
    • Acetazolamide / carbonic anhydrase inhibitors
    • Adrenal insufficiency
    • Pancreatic fistula / drainage
• Respiratory acidosis
  • Acute (CNS depression, airway obstruction, neuromuscular disease, pneumothorax, flail chest)
  • Chronic (COPD, obesity hypoventilation syndrome, neuromuscular disease, chest wall deformity)
• Mixed acid-base disorders (commonly encountered in the ED; e.g. combined metabolic acidosis + respiratory acidosis in overdose; combined anion gap + non-anion gap in DKA with NS resuscitation)

See Also

• Acid-base disorders
• Metabolic alkalosis
• Respiratory alkalosis
• Anion gap
• Osmolar gap
• Toxic Alcohols
• Diabetic Ketoacidosis
• Lactic Acidosis
• Sepsis