Metabolic acidosis

DDX

I. GAP

    1) Lactic acidosis

    2) Renal failure

    3) Ketoacidosis

         a) DM

         b) ETOH

         c) Starvation

         d) High fat diet

    4) Tox ingestion

         a) Inc osm gap

              i) Methanol

              ii) Ethylene glycol

         b) Nl osm gap

              i) Salicylate

              ii) Paraldehyde

              iii) Cyanide

II. NON-GAP

    1) Tendancy hyperKalemia

         a) Resolving DKA

         b) Early uremic acidosis

         c) Early obstructive

         d) RTA Type IV

         f) Hypoaldo

         g) K-sparing diuretics

    2) Tendancy hypoKalemia

         a) RTA Type I

         b) RTA Type II

         c) Acetazolamide

         d) Acute diarrhea

Treatment

Bicarbonate Indications

1) Bicarb <4

2) pH <7.20 + Sx shock/myocardial irritability

3) Severe hyperchloremic acidemia + Sx shock/myocardial irritability

Source

2/21/06 DONALDSON (adapted from Tintinalli)