Key messages

• Metabolic acidosis is classified as increased or normal anion gap acidosis.

• Increased anion gap acidosis is common in the intensive care unit, is often serious, and has a short differential diagnosis in the critically ill.

• The cornerstone of management of metabolic acidosis is correction of the underlying pathophysiological cause.

• Sodium bicarbonate is not necessary in the management of most patients who have metabolic acidosis. Exceptions include profound metabolic acidosis and some specific causes of metabolic acidosis

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