Pathogenesis of different forms of metabolic acidosis

Metabolic acidosis is conveniently classified on the basis of changes in the anion gap. The anion gap is the difference between measured cations (the most important of which quantitatively is sodium (Na+)) and measured anions (Cl- and HCO3-) and is normally 12 ± 2 mmol/l. Unmeasured anions, such as albumin, inorganic phosphate, sulfate, and organic anions, account for the anion gap. Normal anion gap acidosis is caused by HCO 3- loss with replacement by Cl-. Increased anion gap acidosis is caused by accumulation of an organic acid (such as lactic acid), which generates unmeasured anions (such as lactate) when HCO 3- is consumed by buffering of H + (Ba.rD.ett., „§.0d, „.Schmidt ,„1.992; Emmett.etal-, 1.992).

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