The most common causes of<unk>  are: ketoacidosis, lactic<unk> , kidney failure, and toxic ingestions. Ketoacidosis can occur as a complication of diabetes mellitus (diabetic ketoacidosis), but can occur due to other disorders, such as chronic alcoholism and malnutrition. In these conditions, excessive free fatty acid metabolism results in the production of ketoacids, acetoacetic acid, and beta-hydroxybutyrate. Lactic<unk>  results from excess formation and decreased metabolism of lactate, which occurs during states of anaerobic metabolism. It is the most common cause of metabolic<unk>  in hospitalized patients. The most serious form occurs during various states of shock, due to episodes of decreased liver perfusion. Kidney failure results in decreased acid excretion and increased bicarbonate excretion. Toxins that result in acidic metabolites may trigger lactic<unk> . Rhabdomyolysis, a muscle-wasting disease, is a rare cause of metabolic<unk> . Mnemonics Various mnemonics are used to assist clinicians in the detection and diagnosis of conditions that may result in<unk> : The newer 2008 mnemonic "GOLD MARK" was proposed in The Lancet reflecting current causes of<unk> <unk>  metabolic<unk> : * G — glycols (ethylene glycol & propylene glycol) * O — oxoproline, a metabolite of paracetamol (acetaminophen) * L — L-lactate, the chemical responsible for lactic<unk>  * D — D-lactate * M — methanol * A — aspirin * R — renal failure * K — ketoacidosis, ketones generated from starvation, alcohol, and diabetic ketoacidosis The mnemonic MUDPILES is commonly used to remember the causes of increased<unk> <unk>  metabolic<unk> . * M — Methanol * U — Uremia (chronic kidney failure) * D — Diabetic ketoacidosis * P — Paracetamol, Propylene glycol (used as an inactive stabilizer in many medications; historically, the "P" also stood for Paraldehyde, though this substance is not commonly used today) * I — Infection, Iron, Isoniazid (which can cause lactic<unk>  in overdose), Inborn errors of metabolism (an especially important consideration in pediatric patients) * L — Lactic<unk>  * E — Ethylene glycol (Note: Ethanol is sometimes included in this mnemonic as well, although the<unk>  caused by ethanol is actually primarily due to the increased production of lactic acid found in such intoxication.) * S — Salicylates Another frequently used mnemonic is KARMEL. * K — Ketoacidosis * A — aspirin * R — Renal failure * M — Methanol * E — Ethylene glycol * L — Lactic<unk>  Another frequently used mnemonic is KULT. ACEGIFTS is a mnemonic for the toxins. * K — Ketoacidosis (DKA, Alcoholic ketoacidosis) * U — Uremia * L — Lactic<unk>  * T — Toxins (Ethylene glycol, methanol, as well as drugs, such as aspirin, Metformin) The mnemonic for toxins is ACE GIFTs: Aspirin, Cyanide, Ethanolic ketosis, Glycols (ethylene and propylene), Isoniazid, Ferrous iron, Toluene, salicylates. Most of these cause a lactic<unk> . Other * formaldehyde * toluene * sulfates * metformin * rhabdomyolysis
High anion gap metabolic acidosis
Alcoholic ketoacidosis
Normal anion gap acidosis
Metabolic alkalosis
Metabolic acidosis
Respiratory acidosis
Respiratory alkalosis
Contraction alkalosis