title: Non-Anion Gap Metabolic Acidosis: A Clinical Approach to Evaluation.
abstract: 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.
authors.affiliation: Nephrology Section, VA Greater Los Angeles Healthcare System, David Geffen School of Medicine at UCLA, Los Angeles, CA.
authors.forename: Mandana
authors.initials: M
authors.lastname: Rastegar
authors.affiliation: Nephrology Section, VA Greater Los Angeles Healthcare System, David Geffen School of Medicine at UCLA, Los Angeles, CA. Electronic address: glenn.nagami@va.gov.
authors.forename: Glenn T
authors.initials: GT
authors.lastname: Nagami
mesh_terms: D000136:Acid-Base Equilibrium; D000138:Acidosis / Q000175:diagnosis*; D000368:Aged; D006801:Humans; D008297:Male
keywords: Non–anion gap metabolic acidosis; acid-base; high volume ileostomy output; renal acidification; urinary ammonium; urine anion gap; urine osmolal gap