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Metabolic acidosis has three main root causes: increased acid production, loss of bicarbonate, and a reduced ability of the kidneys to excrete excess acids. [5] Metabolic acidosis can lead to acidemia, which is defined as arterial blood pH that is lower than 7.35. [6]
The magnitude of this difference (i.e., "gap") in the serum is calculated to identify metabolic acidosis. If the gap is greater than normal, then high anion gap metabolic acidosis is diagnosed. The term "anion gap" usually implies "serum anion gap", but the urine anion gap is also a clinically useful measure. [4] [5] [6] [7]
High anion gap metabolic acidosis is typically caused by acid produced by the body. More rarely, it may be caused by ingesting methanol or overdosing on aspirin . [ 1 ] [ 2 ] The delta ratio is a formula that can be used to assess elevated anion gap metabolic acidosis and to evaluate whether mixed acid base disorder (metabolic acidosis) is present.
It is used to aid in the differential diagnosis of metabolic acidosis. [2] The term "anion gap" without qualification usually implies serum anion gap. The "urine anion gap" is a different measure, principally used to determine whether the kidneys are capable of appropriately acidifying urine.
The HCO − 3 ion indicates whether a metabolic problem is present (such as ketoacidosis). A low HCO − 3 indicates metabolic acidosis, a high HCO − 3 indicates metabolic alkalosis. As this value when given with blood gas results is often calculated by the analyzer, correlation should be checked with total CO 2 levels as directly measured ...
Metabolic acidosis is compensated for in the lungs, as increased exhalation of carbon dioxide promptly shifts the buffering equation to reduce metabolic acid. This is a result of stimulation to chemoreceptors , which increases alveolar ventilation , leading to respiratory compensation, otherwise known as Kussmaul breathing (a specific type of ...
When this happens the numerator is large, the denominator is small, and the result is a delta ratio which is high (>2). This means a combined high anion gap metabolic acidosis and a pre-existing either respiratory acidosis or metabolic alkalosis (causing the high bicarbonate) – i.e. a mixed acid–base metabolic acidosis. [citation needed]
In general, the cause of a hyperchloremic metabolic acidosis is a loss of base, either a gastrointestinal loss or a renal loss [citation needed]. Gastrointestinal loss of bicarbonate (HCO − 3) [citation needed] Severe diarrhea (vomiting will tend to cause hypochloraemic alkalosis) Pancreatic fistula with loss of bicarbonate rich pancreatic fluid