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
  - 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)

Acidosis

See Also