Which causes hyperchloremic metabolic acidosis: (A) Ethylene glycol poison, (B) DKA, (C) Lactic acidosis, (D) Diarhhea
Answer is D. The causes of a hyperchloremic metabolic acidosis is a loss of the base, either a gastrointestinal loss or a renal loss.Gastrointestinal loss of bicarbonate (HCO-3)Severe diarrhoeaPancreatic fistula with loss of bicarbonate-rich pancreatic fluidNasojejunal tube losses in the context of small bowel obstructionChronic laxative abuseRenal causesProximal renal tubular acidosis with a failure of HCO-3 resorptionDistal renal tubular acidosis with a failure of H+ secretionLong-term use of a carbonic anhydrase inhibitor such as acetazolamide