Review of Clinical Disorders Causing Metabolic Acidosis

Area of Science:

• Nephrology
• Internal Medicine
• Acid-Base Balance

Background:

• Metabolic acidosis is a common clinical condition with various underlying causes.
• Prompt diagnosis and identification of the etiology are crucial for effective patient management.
• Clinical presentation and initial laboratory findings often suggest the cause.

Purpose of the Study:

• To review the mechanisms of metabolic acidosis.
• To categorize metabolic acidoses based on mechanism and anion gap.
• To guide clinicians in diagnosing the etiology of metabolic acidosis.

Main Methods:

• Review of existing literature on metabolic acidosis.
• Categorization of metabolic acidosis by underlying mechanism.
• Classification based on the presence or absence of an increased anion gap.
• Stepwise diagnostic approach considering clinical presentation and laboratory data.

Main Results:

• Metabolic acidoses can be categorized by mechanism and anion gap status (normal or high).
• History and physical examination are key to identifying obvious causes like diabetic ketoacidosis or lactic acidosis.
• Anion gap determination is critical when the etiology is not immediately apparent.
• A structured diagnostic approach aids in selecting appropriate investigations.

Conclusions:

• Understanding the mechanisms and categorization of metabolic acidosis is essential for diagnosis.
• Differentiating between hyperchloremic and high-anion-gap metabolic acidosis facilitates etiological diagnosis.
• A systematic approach, integrating clinical data and anion gap status, guides diagnostic workup for metabolic acidosis.