Non-anion Gap Metabolic Acidosis: A Clinical Approachtoevaluation.
1. Am J Kidney Dis. 2017 Feb;69(2):296-301. doi: 10.1053/j.ajkd.2016.09.013. Epub2016 Oct 28. Non-Anion Gap Metabolic Acidosis: A Clinical ApproachtoEvaluation. (1)Nephrology Section, VA Greater Los Angeles Healthcare System, David Geffen School of Medicine at UCLA, Los Angeles, CA. (2)Nephrology Section, VA Greater Los Angeles Healthcare System, David Geffen School of Medicine at UCLA, Los Angeles, CA. Electronic address: [email protected] Acid-base disturbances can result from kidney or nonkidney disorders. We present a case of high-volume ileostomy output causing large bicarbonate losses andresulting in a non-anion gap metabolic acidosis. Non-anion gap metabolic acidosiscan present as a form of either acute or chronic metabolic acidosis. A completeclinical history and physical examination are critical initial steps to begin theevaluation process, followed by measuring serum electrolytes with a focus onpotassium level, blood gas, urine pH, and either direct or indirect urineammonium concentration. The present case was selected to highlight thedifferential diagnosis of a non-anion gap metabolic acidosis and illustrate asystematic approach to this problem.Published by Elsevier Continue reading >>