Non-Anion Gap Metabolic Acidosis: A Clinical Approach to Evaluation

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• 作者：Mandana Rastegar ; MD ; EdM ; Glenn T. Nagami ; MD ; ^{glenn.nagami@va.gov}
• 关键词：Non&ndash ; anion gap metabolic acidosis ; urine anion gap ; urine osmolal gap ; renal acidification ; acid-base ; high volume ileostomy output ; urinary ammonium
• 刊名：American Journal of Kidney Diseases
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：69
• 期：2
• 页码：296-301
• 全文大小：246 K
• 卷排序：69

文摘

Acid-base disturbances can result from kidney or nonkidney disorders. We present a case of high-volume ileostomy output causing large bicarbonate losses and resulting in a non–anion gap metabolic acidosis. Non–anion gap metabolic acidosis can present as a form of either acute or chronic metabolic acidosis. A complete clinical history and physical examination are critical initial steps to begin the evaluation process, followed by measuring serum electrolytes with a focus on potassium level, blood gas, urine pH, and either direct or indirect urine ammonium concentration. The present case was selected to highlight the differential diagnosis of a non–anion gap metabolic acidosis and illustrate a systematic approach to this problem.