> For the complete documentation index, see [llms.txt](https://thisispiggy.gitbook.io/my-wiki/llms.txt). Markdown versions of documentation pages are available by appending `.md` to page URLs; this page is available as [Markdown](https://thisispiggy.gitbook.io/my-wiki/01-step-1/renal/12-metabolic-acidosis.md).

# 12 Metabolic Acidosis

## Anion Gap

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Renal/Chem%207%20is/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/3G2l3qq.jpg)

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Renal/Anion%20gap%20equation.%20Normal)..

![](https://f001.backblazeb2.com/file/wikiFiles/Ro8xiu5.jpg)

* blood: total number of + must equal -
* chem 7 only tells some of the positive and negative charges
* Na and K (positive) minus Cl and bicarb (negative) is the gap
* in reality no gap, just other ions not measured

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Renal/what%20is%20anion%20gap.%20Low%20anion%20gap%20causes)..

![](https://f001.backblazeb2.com/file/wikiFiles/BlLVLdi.jpg)

* albumin predominantly responsible for negative anions besides Cl/bicarb
  * for every 1 g decrease in albumin, add 2.5 to AG
* IgG push Na out and retain K in plasma: shrink anion gap

A low anion gap is frequently caused by hypoalbuminemia. Albumin is a negatively charged protein and its loss from the serum results in the **retention of other negatively charged ions such as chloride and bicarbonate**. As bicarbonate and chloride anions are used to calculate the anion gap, there is a subsequent decrease in the gap.

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Renal/why%20is%20anion%20gap%20important.%20Reason%20for%20normal%20and%20increase%20anion%20gap)..

![](https://f001.backblazeb2.com/file/wikiFiles/ArpEV0w.jpg)

* if lose bicarb, compensate with Cl to maintain normal charge

![](https://f001.backblazeb2.com/file/wikiFiles/CUU2bcp.jpg)

* Cl part of anion gap ion, thus normal AG

\[*]\(.*\
\&#xNAN;*\<img src='images/v74QhnD.jpg' alt='*' />\
.)..

![](https://f001.backblazeb2.com/file/wikiFiles/v74QhnD.jpg)

* top: bicarb decreased (met acidosis). Cl increased, normal 95 (non-AG)
* bottom: met acidosis, Cl not high, AG
* **Cl up: non-AG; Cl down: AG**

## Winter's Formula

\[\_]\(Winter's formula and delta ratio uses)..

![](https://f001.backblazeb2.com/file/wikiFiles/LfZFju4.jpg)

\[\_]\(winter's formula use when)..

![](https://f001.backblazeb2.com/file/wikiFiles/GZapzZD.jpg)

## Delta Delta

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Renal/delta%20ratio%20is,%20uses/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/8Mv2TfV.jpg)

* Winter's tell if there's secondary respiratory, Delta ratio tells if secondary metabolic

![](https://f001.backblazeb2.com/file/wikiFiles/QCbfIrA.jpg)

* <1: bicarb driven down by metabolic acidosis also by something else
* more than 2: chronic respiratory acidosis causing chronic retention of bicarb

![](https://f001.backblazeb2.com/file/wikiFiles/TlAQ0Ef.jpg)

## Non- AG Causes

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Renal/non%20AG%20gap%20metabolic%20acidosis%20causes/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/299wdsN.jpg)

* anything that lowers aldosterone, decreases bicarb level, or increases H+ levels
* addison: can't make aldosterone
* saline: low aldosterone result
* hyperalimentation: IV nutrition
* calculate urinary AG
* Na+K-Cl = urine bicarb
* positive: renal loss
* negative: GI loss
* TB: adrenal insufficiency

## AG Acidosis Causes

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Renal/anion%20gap%20metabolic%20acidosis%20equation/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/sj6IRu9.jpg)

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Renal/anion%20gap%20metabolic%20acidosis%20causes/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/HZU4HCb.jpg)

* MUD PILES

### Methanol

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Renal/methanol%20found%20in,%20metabolized%20to,%20symptoms,%20classic%20scenario,%20treatment/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/yU9r0Gj.jpg)

* destroy optic disc&#x20;

![](https://f001.backblazeb2.com/file/wikiFiles/0jgSYr5.jpg)

* child, suicide, etc.
* very important: **visual symptoms**

![](https://f001.backblazeb2.com/file/wikiFiles/cDlcg98.jpg)

### Ethylene Glycol

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Renal/ethylene%20glycol%20metabolized%20to,%20found%20in,%20symptoms,%20classic%20scenario,%20treatment/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/PiDYt3g.jpg)

* calcium oxalate in tubules

![](https://f001.backblazeb2.com/file/wikiFiles/vruSRxJ.jpg)

* kidney symptoms instead of visual

![](https://f001.backblazeb2.com/file/wikiFiles/cDlcg98.jpg)

* formaldehyde: formic acid
* glycoladehyde: glycolate, oxalate

### Propylene Glycol

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Renal/propylene%20glycol%20found%20in,%20metabolized%20to,%20symptoms,/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/LIdvUlr.jpg)

### Isopropyl Alcohol

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Renal/isopropyl%20alcohol%20found%20in,%20metabolized%20to,%20symptoms/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/GbggdDc.jpg)

* someone ingest toxic product but no AG acidosis

### Uremia

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Renal/uremia%20causes,%20result,%20symptoms/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/niHGqwN.jpg)

* at first: can't excrete H
* later: can't excrete organic acids
* association with other uremic symptoms (pericarditis, confusion, hyperkalemia)

### DKA

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Renal/DKA%20causes,%20symptoms,%20acidosis%20how,%20treatment/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/XJVhDXi.jpg)

* or diabetic who didn't take insulin

![](https://f001.backblazeb2.com/file/wikiFiles/R6YJBfh.jpg)

### Lactic Acidosis

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Renal/lactic%20acedosis%20causes,%20symptoms,%20converted%20from/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/oN6rGMx.jpg)

* seizures: so much muscle contraction

### Iron

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Renal/iron%20poison%20causes,%20symptoms,%20acidosis%20from/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/3DqJX2c.jpg)

* usually child
* highly prone to bleeding
* later phase: AG acidosis

![](https://f001.backblazeb2.com/file/wikiFiles/QyyQUEt.jpg)

* ferric irons: unmeasured anions

### INH

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Renal/INH%20SE%20symptoms/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/Cd8G5V8.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/uvHSCoF.jpg)

* Motion lines: INH may cause seizures
* MUD PILES: INH may cause anion gap metabolic acidosis

### Aspirin

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Renal/aspirin%20acidosis%20from,%20pathogenesis/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/RO7NRLb.jpg)

![](https://i.imgur.com/t7MSOYP.jpg)

* Mudpile: aspirin toxicity can cause an anion gap metabolic acidosis (S in MUDPILES)
* Blowing “OH-” bubbles: aspirin causes a respiratory alkalosis, stimulate respiratory center directly