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  • • Decreased serum pH (< 7.35)

    • Decreased serum HCO3


  • • Etiologies include:

    • -Diarrhea


      -Renal tubular disease


      -Lactic acidosis

      -Diabetic ketoacidosis


Laboratory Findings

  • • Decreased serum pH (< 7.35)

    • Decreased serum HCO3

  • • Differentiate between anion gap or hyperchloremic causes

  • • Serum electrolytes

    • ABG measurements

    • Calculate anion gap: Na - (Cl + HCO3)

    • Anion gap > 15: H+ excess, lactic acidosis, diabetic ketoacidosis, uremia, methanol ingestion, salicylate intoxication, ethylene glycol ingestion

    • Anion gap < 15: HCO3 loss, diarrhea, renal tubular disease, ureterosigmoidostomy, acetazolamide, NH4 Cl administration

  • • Treat underlying condition

    Conservative HCO3 administration: Estimate need by multiplying base deficit by one half total body water


  • • Sodium bicarbonate as needed

Treatment Monitoring

  • • Serial ABG measurements


  • • Hypotension

    • Death


  • • Varies with etiology


Adrogue HJ et al. Management of life-threatening acid-base disorders. (Two parts.) N Engl J Med. 1998;338:26, 107.
Ishihara K et al. Anion gap acidosis. Semin Nephrol. 1998;18:83.  [PubMed: 9459291]

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