Makindo Medical Notes"One small step for man, one large step for Makindo" |
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Related Subjects: |Metabolic acidosis |Aspirin or Salicylates toxicity |Ethylene glycol toxicity |Renal Tubular Acidosis |Lactic acidosis |Metabolic alkalosis
🔺 High Anion Gap | ➡️ Normal Anion Gap |
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Anion | Clinical Case |
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🧪 L-Lactate | Anaerobic metabolism (shock, sepsis). |
🍩 Beta-hydroxybutyrate | Diabetic ketoacidosis. |
🧴 Hippurate | Toluene poisoning (glue sniffers). |
🥛 Glycolate & Oxalate | Methanol/ethylene glycol ingestion. |
🌿 D-Lactate | Gut fermentation (e.g., blind loop syndrome). |
Cause | Clinical Features | Diagnostic Tests | Management |
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💉 Lactic Acidosis | Shock, sepsis, hypoxia, confusion, tachypnoea. | ABG (low pH/HCO₃⁻), serum lactate ↑. | Oxygen, IV fluids, treat cause, inotropes (noradrenaline if septic shock). |
🍩 Ketoacidosis | Polyuria, polydipsia, fruity breath, dehydration, confusion. | ABG (low pH, low HCO₃⁻), ketones ↑, glucose ↑ (DKA). | IV fluids, insulin infusion (if DKA), K⁺ replacement, monitor glucose & ketones. |
🩺 Renal Failure | Oedema, oliguria, confusion, uremia. | Creatinine ↑, urea ↑, ABG acidosis, electrolytes (hyperkalaemia). | Dialysis if severe, correct underlying cause, treat K⁺ imbalance. |
☠️ Toxins | Visual loss (methanol), renal failure (ethylene glycol), tinnitus (salicylates). | ABG: HAGMA, osmolar gap ↑, toxin assays. | Fomepizole, dialysis, bicarbonate (salicylates). |
💩 Diarrhoea | Loose stools, dehydration, cramps, lethargy. | ABG: NAGMA, low K⁺, low Na⁺. | Rehydrate (oral/IV), replace electrolytes, treat cause (infection, malabsorption). |
⚡ Renal Tubular Acidosis | Polyuria, weakness, bone pain, growth delay (children). | ABG: NAGMA, urine pH pattern, electrolytes. | Oral bicarbonate (NaHCO₃ or K-citrate), treat cause. |
🧂 Hyperchloremic Acidosis | Weakness, confusion, oedema if fluid overload. | ABG: NAGMA, Cl⁻ ↑, HCO₃⁻ ↓. | Stop saline infusion, use balanced fluids (Hartmann’s/Ringer’s), correct electrolytes. |
A 24-year-old woman with type 1 diabetes presents with abdominal pain, vomiting, and drowsiness. Vitals: HR 120, BP 95/60, RR 28 with Kussmaul breathing. Labs: glucose 28 mmol/L, ketones 6 mmol/L, pH 7.15, HCO₃⁻ 10 mmol/L. Management: 💉 Fixed-rate IV insulin infusion, IV fluids (0.9% saline initially), potassium replacement as guided, identify trigger (infection). Avoid: ❌ Bicarbonate therapy unless pH <6.9; avoid rapid fluid shifts in young patients (risk of cerebral oedema).
A 68-year-old man presents with fever, hypotension, and confusion. BP 80/50, HR 120, lactate 6.2 mmol/L, pH 7.22, HCO₃⁻ 14 mmol/L. Diagnosis: septic shock with lactic acidosis. Management: 🚑 Sepsis 6 bundle — IV fluids, broad-spectrum antibiotics, oxygen, source control. Consider vasopressors if hypotension persists. Avoid: ❌ Delaying antibiotics; avoid excessive normal saline (can worsen acidosis with hyperchloraemia).
A 75-year-old woman with stage 5 chronic kidney disease presents with progressive weakness, nausea, and confusion. Labs: pH 7.28, HCO₃⁻ 16 mmol/L, high urea and creatinine, potassium 6.0 mmol/L. Management: 🩺 Sodium bicarbonate therapy if symptomatic and not fluid overloaded, treat hyperkalaemia, dialysis if severe or refractory. Avoid: ❌ Relying on IV fluids alone; avoid potassium-sparing drugs (e.g. spironolactone, ACEI) in the acute setting.