Metabolic acidosis is a common metabolic derangement present in the acute medical patient. A thorough and structured investigative approach is required as there are many causes and management is reliant on identifying these. In particular calculation of the anion gap with correction for albumin level and use of the delta ratio can be helpful in complex cases especially in patients where a combination of metabolic derangements may be present.
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References
Hall T. PACES for the MRCP, Second Edition 2008. Churchill Livingstone Elsevier
Cameron P, Jelinek G, Kelly AM. Textbook of Adult Emergency Medicine, 3rd edition 2009
Yentis SM, Hirsch NP, Smith GB. Anaesthesia and Intensive Care – An Encyclopaedia of Principles and Practice. Third Edition. 2004
Carmody JB. Norwood VF. A clinical approach to paediatric acid-base disorders.Postgraduate Medical Journal. 2012 ; 88(1037):143–51.
Wrenn K. The Delta Gap: An approach to mixed acid-base disorders. Annals of Emergency Medicine, Nov 1990 gfj; 19(11);1310–13.
Hatherill M, Waggie Z, Purves, et al. Correction of the anion gap for albumin in order to detect occult tissue anions in shock. Arch Dis Child 2002; 87: 526–529.
Kalra PA. Essential Revision Notes for MRCP. 2nd Edition 2003. Bosley TM, Salih MA, Alorainy IA, et al. The Neurology of Carbonic Anhydrase type II Deficiency Syndrome. Brain. 2011 Dec; 134(12): 3502–15.
Kraut JA. Kurtz I. Metabolic acidosis of CKD: diagnosis, clinical characteristics, and treatment. American Journal of Kidney Diseases. 2005 Jun; 45(6): 978–93.
Reddy P, Clinical approach to renal tubular acidosis in adult patients. International Journal of Clinical Practice. 2011 Mar; 65(3):350–60.
Kim GH, Han JS, Kim YS et al. Evaluation of urine acidification by urine anion gap and urine osmolal gap in chronic metabolic acidosis. American Journal of Kidney Diseases. 1996 Jan; 27(1): 42–7.
Dyck RF. Asthana S. Kalra J et al. A modification of the urine osmolal gap: an improved method for estimating urine ammonium. American Journal of Nephrology. 1990; 10(5): 359–62.
Emmet M, Urine anion and osmolar gaps in metabolic acidosis. Up to date Feb 2012
Sabatini S, KurtzmanNA.Bicarbonate Therapy in Severe Metabolic Acidosis. JASN April 2009; 20(4): 692–695.
Kraut JA. Madias NE. Metabolic acidosis: pathophysiology, diagnosis and management. Nature Reviews Nephrology. 2010 May; 6(5): 274–85.
Friedrich C L.Lactic Acidosis Update for Critical Care Clinicians. JASN February 1, 2001; 12 no. suppl: 1S15–S19.
Nolan J, Soar J, Lockey A.Advanced Life Support. 6th Edition. Resuscitation Council. Jan 2011.
Metabolic acidosis is a common metabolic derangement present in the acute medical patient. A thorough and structured investigative approach is required as there are many causes and management is reliant on identifying these. In particular calculation of the anion gap with correction for albumin level and use of the delta ratio can be helpful in complex cases especially in patients where a combination of metabolic derangements may be present.
Hall T. PACES for the MRCP, Second Edition 2008. Churchill Livingstone Elsevier
Cameron P, Jelinek G, Kelly AM. Textbook of Adult Emergency Medicine, 3rd edition 2009
Yentis SM, Hirsch NP, Smith GB. Anaesthesia and Intensive Care – An Encyclopaedia of Principles and Practice. Third Edition. 2004
Carmody JB. Norwood VF. A clinical approach to paediatric acid-base disorders.Postgraduate Medical Journal. 2012 ; 88(1037):143–51.
Wrenn K. The Delta Gap: An approach to mixed acid-base disorders. Annals of Emergency Medicine, Nov 1990 gfj; 19(11);1310–13.
Hatherill M, Waggie Z, Purves, et al. Correction of the anion gap for albumin in order to detect occult tissue anions in shock. Arch Dis Child 2002; 87: 526–529.
Kalra PA. Essential Revision Notes for MRCP. 2nd Edition 2003. Bosley TM, Salih MA, Alorainy IA, et al. The Neurology of Carbonic Anhydrase type II Deficiency Syndrome. Brain. 2011 Dec; 134(12): 3502–15.
Kraut JA. Kurtz I. Metabolic acidosis of CKD: diagnosis, clinical characteristics, and treatment. American Journal of Kidney Diseases. 2005 Jun; 45(6): 978–93.
Reddy P, Clinical approach to renal tubular acidosis in adult patients. International Journal of Clinical Practice. 2011 Mar; 65(3):350–60.
Kim GH, Han JS, Kim YS et al. Evaluation of urine acidification by urine anion gap and urine osmolal gap in chronic metabolic acidosis. American Journal of Kidney Diseases. 1996 Jan; 27(1): 42–7.
Dyck RF. Asthana S. Kalra J et al. A modification of the urine osmolal gap: an improved method for estimating urine ammonium. American Journal of Nephrology. 1990; 10(5): 359–62.
Emmet M, Urine anion and osmolar gaps in metabolic acidosis. Up to date Feb 2012
Sabatini S, KurtzmanNA.Bicarbonate Therapy in Severe Metabolic Acidosis. JASN April 2009; 20(4): 692–695.
Kraut JA. Madias NE. Metabolic acidosis: pathophysiology, diagnosis and management. Nature Reviews Nephrology. 2010 May; 6(5): 274–85.
Friedrich C L.Lactic Acidosis Update for Critical Care Clinicians. JASN February 1, 2001; 12 no. suppl: 1S15–S19.
Nolan J, Soar J, Lockey A.Advanced Life Support. 6th Edition. Resuscitation Council. Jan 2011.
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Consultant Acute Medicine,
Royal Alexandra Hospital,
Paisley
Problem-Based Review: A patient with metabolic acidosis
Cite this article as:
Allan R, Foster C. Problem-based review: A patient with metabolic acidosis. Acute Med. 2012;11(4):251-6. PMID: 23364112.
Problem-Based Review: A patient with metabolic acidosis
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