Table 3.

Causes of metabolic acidosis with increased anion gap

Increased acid production

Lactic acidosis

Type A: associated with clinical evidence of poor tissue perfusion or oxygenation of blood

Type B: associated with no clinical evidence of poor tissue perfusion or oxygenation of blood

Type D: associated with several causes of the short bowel syndrome with metabolization and absorption of D-lactic acid into the systemic circulation

Ingestions

Methanol

Ethylene glycol

Toluene (if early)

Aspirin

Diethylene glycol

Propylene glycol

Ketoacidosis

Diabetes mellitus

Alcohol-associated

Starvation

Pyroglutamic acid (5-oxoproline)

Decreased renal acid excretion

Chronic kidney disease