Etiologies of Non-AG Metabolic Acidosis

GI losses of HCO3

Diarrhea, intestinal or pancreatic fistulas or drainage

RTAs

Early renal failure

  • Impaired generation of ammonia

Ingestions

  • Acetazolamide, sevelamer, cholestyramine, toluene

Dilutional

  • Due to rapid infusion of bicarbonate-free IV fluids

Posthypocapnia

  • Respiratory alkalosis → renal wasting of HCO3; rapid correction of resp. alk. → transient acidosis until HCO3 regenerated

Ureteral diversion

  • Colonic Cl–/HCO3– exchange, ammonium reabsorption