METABOLIC ACIDOSIS                        <A-RespAc.TXT>
                        様様様様様様様様様

Renal Tubular Acidosis  <A-RTA.TXT>
Pseudo-acidosis         <L-HCO3.TXT>
D-Lactic Acidosis       <ShortGut.TXT -acidosis>

First question:  is it adequately compensated?
Use Winter's Formula:  pH = 1.5 ([HCO3-] + 8) +- 2  for good compensation
except:  lactic acidosis may have overcompensation due to CNS effects.

2. Anion Gap vs. Non-anion-gap (Hyperchloremic):
   i. [Na+] - ([Cl-] + [HCO3-]) >> 12  is anion gap acidosis
   ii. [Na+] - ([Cl-] + [HCO3-]) ~= 12  is hyperchloremic acidosis
   iii.  in anion gap should be same as  in HCO3-, or has BOTH anion-
      gap and non-anion-gap metabolic acidoses.
3. High Anion Gap Metabolic Acidoses
   i. Mnemonics:
     MUDPILES:
      M- methanol
      U- uremia
      D- diabetic ketoacidosis
      P- paraldehyde
      I- iron/isoniazid (INH)
      L- lactic acidosis
      E- ethanol
      S- salicylates (and acetaminophen)
     KUSMAL:
      K- ketoacidosis
      U- uremia
      S- salicylates
      M- methanol (and ethelyne glycol, pareldehyde)
      A- alcohol (EtOH)
      L- lactic acidosis
         can come from metformin (e.g., Glucophage) <d-dm.txt -acidosis>
4. Normal Anion Gap (Hyperchloremic) Metabolic Acidoses
   i. high K+ vs. low K+
      a. high K+
         1. hyperal and increased amino acid catabolism
         2. post-hypocapnic (it takes a while for the HCO3- to rise)
         3. dilutional
         4. hypoaldo (either from low renin or adrenal dysfunction)
         5. NH4Cl, CaCl2, lysine, or arginine (effectively adds HCl)
      b. low K+
         1. GI-- diarrhea, fistulas (K+ loss and high aldo)
         2. GU-- surgical ureteral conduits
         3. RTA-- see separate section.
   ii. Urine pH < 5.0 or > 5.5
      a. urine pH < 5.0-- suggests interstitial nephritis and a defect
         in NH4+ and NH3 buffering
      b. urine pH > 5.5-- suggests RTA