Non-Anion Gap Metabolic Acidosis: Clinical Approach and Pathophysiologic Mechanism

Pathophysiologic Mechanism

• The American Society of Nephrology acknowledges that the hyperchloremic pattern occurs because when bicarbonate is lost, effective extracellular volume decreases, triggering increased renal chloride reabsorption from dietary sources to maintain electroneutrality, which decreases the strong ion difference and lowers pH 2

Clinical Approach to Diagnosis and Management

• The American Diabetes Association notes that the recovery phase of diabetic ketoacidosis produces transient non-anion gap acidosis as chloride from IV fluids replaces ketoanions lost during osmotic diuresis, and this condition is biochemically insignificant and does not require specific intervention unless acute renal failure or extreme oliguria is present 1