Version April 2023
| Mechanism of acidosis | Increased AG | Normal AG |
| Increased acid production | Lactic acidosis | |
| Ketoacidosis | ||
| Diabetes mellitus | ||
| Starvation | ||
| Alcohol associated | ||
| Ingestions | ||
| Methanol | ||
| Ethylene glycol | ||
| Aspirin | ||
| Toluene (if early or if kidney function is impaired) | Toluene ingestion (if late and if kidney function is preserved; due to excretion of sodium and potassium hippurate in the urine) | |
| Diethylene glycol | ||
| Propylene glycol | ||
| D-lactic acidosis | A component of non-AG metabolic acidosis may coexist due to urinary excretion of D-lactate as Na and K salts (which represents potential HCO3) | |
| Pyroglutamic acid (5-oxoproline) | ||
| Loss of bicarbonate or bicarbonate precursors | Diarrhea or other intestinal losses (eg, tube drainage) | |
| Type 2 (proximal) RTA | ||
| Posttreatment of ketoacidosis | ||
| Carbonic anhydrase inhibitors | ||
| Ureteral diversion (eg, ileal loop) | ||
| Decreased renal acid excretion | Severe kidney dysfunction (eGFR <15 to 20 mL/min/1.73 m2) | Moderate kidney dysfunction (eGFR >15 to 20 mL/min/1.73 m2) |
| Type 1 (distal) RTA (hypokalemic) | ||
| Hyperkalemic RTA | ||
| Type 4 RTA (hypoaldosteronism) | ||
| Voltage defect | ||
| Large volume infusion of normal saline | Diffusion acidosis |
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