Version May 2024
| Elevated anion gap |
| Lactic acidosis |
| Hypoperfusion |
| Cardiac failure |
| Hypovolemia |
| Septic shock |
| Mitochondrial disorders |
| Mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes (MELAS) |
| Myoclonic epilepsy with ragged red fibers (MERRF) |
| Kearns-Sayre syndrome |
| Acquired (antiretroviral therapy in HIV patients) |
| Inborn errors of carbohydrate metabolism |
| Fructose-1,6-diphosphatase deficiency |
| Glycogen storage disease 1 (glucose-6-phosphatase deficiency) |
| Pyruvate dehydrogenase or carboxylase deficiency |
| Ketoacidosis |
| Diabetic ketoacidosis |
| Inborn errors of metabolism |
| Organic acidemia |
| Maple syrup urine disease (branched-chain amino acids) |
| Propionic acidemia |
| Methylmalonic acidemia |
| Ketothiolase deficiency |
| Multiple carboxylase deficiency (impaired biotin utilization) |
| Fatty acid oxidation defects |
| Ingestions |
| Cyanide poisoning |
| Ethanol intoxication |
| Ethylene glycol |
| Iron poisoning |
| Metformin poisoning |
| Methanol |
| Nonsteroidal antiinflammatory drug poisoning |
| Salicylates |
| Kidney failure |
| Massive rhabdomyolysis |
| Tumor lysis syndrome |
| Normal anion gap (hyperchloremic metabolic acidosis) |
| Loss of HCO3 |
| Gastrointestinal loss |
| Diarrhea |
| Chronic laxative abuse |
| Enteric fistulae |
| Ureterosigmoidostomy |
| Kidney loss |
| HCO3 loss |
| Proximal (type 2) renal tubular acidosis |
| Drugs inhibiting proximal tubular carbonic anhydrase |
| Acetazolamide |
| Methazolamide |
| Dichlorphenamide |
| Topiramate |
| Drugs causing proximal tubular injury |
| Aminoglycosides |
| Cisplatin |
| Ifosfamide |
| Tenofovir |
| Cidofovir |
| Heavy metals such as lead, cadmium, and mercury |
| Diminished acid (H+) secretion |
| Distal (type 1) renal tubular acidosis |
| Early kidney failure |
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