Hyperchloremic acidosis
Hyperchloremic acidosis is a form of metabolic acidosis associated with a normal anion gap, a decrease in plasma bicarbonate concentration, and an increase in plasma chloride concentration. Although plasma anion gap is normal, this condition is often associated with an increased urine anion gap, due to the kidney's inability to secrete ammonia.
Causes
In general, the cause of a hyperchloremic metabolic acidosis is a loss of base, either a gastrointestinal loss or a renal loss.- Gastrointestinal loss of bicarbonate
- * Severe diarrhea
- * Pancreatic fistula with loss of bicarbonate rich pancreatic fluid
- * Nasojejunal tube losses in the context of small bowel obstruction and loss of alkaline proximal small bowel secretions
- * Chronic laxative abuse
- Renal causes
- * Proximal renal tubular acidosis with failure of resorption
- * Distal renal tubular acidosis with failure of secretion
- * Long-term use of a carbonic anhydrase inhibitor such as acetazolamide
- Other causes
- * Ingestion of ammonium chloride, hydrochloric acid, or other acidifying salts
- * The treatment and recovery phases of diabetic ketoacidosis
- * Volume resuscitation with 0.9% normal saline provides a chloride load, so that infusing more than 3–4L can cause acidosis
- * Hyperalimentation