Hyperchloremic acidosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Usually the HCO₃^– lost is replaced by a chloride anion, and thus there is a normal anion gap. In normal anion gap acidosis, the increased anion is chloride, which is measured, so the anion gap does not increase. Thus, normal anion gap acidosis is also known as hyperchloremic acidosis. Urine anion gap is useful in evaluating a patient with a normal anion gap.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

The mnemonic for the most common causes of a normal-anion gap metabolic acidosis is “DURHAM.”

• D– Diarrhea

• U– Ureteral diversion

• R– Renal tubular acidosis

• H– Hyperailmentation

• A– Addison’s disease, acetazolamide, ammonium chloride

• M– Miscellaneous (chloridorrhea, amphotericin B, toluene – toluene causes high anion gap metabolic acidosis followed by normal anion gap metabolic acidosis.

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