Wallach's Interpretation of Diagnostic Tests: Pathways to Arriving at a Clinical Diagnosis (620 page)

   Urine electrolytes every 6 hours

   Associated or compensatory metabolic or respiratory disturbances (e.g., hyperventilation or respiratory alkalosis) may result in normal pH

   Type A caused by tissue hypoxia (e.g., acute hemorrhage, severe anemia, shock, asphyxia), marathon running, seizures

   Type B without tissue hypoxia caused by

   Common disorders (e.g., DM, uremia, liver disease, infections, malignancies, alkaloses).

   Drugs and toxins (e.g., ethanol, methanol, ethylene glycol, salicylates, metformin).

   Hereditary enzyme defects (e.g., methylmalonic acidemia, propionic aciduria, defects of fatty acid oxidation, pyruvate dehydrogenase deficiency, pyruvate carboxylase deficiency, multiple carboxylase deficiency, glycogen storage disease type I).

   Others (e.g., starvation, short bowel syndrome).

   With a typical clinical picture (acute onset following nausea and vomiting, altered state of consciousness, hyperventilation, high mortality).

   Decreased serum bicarbonate.

   Low serum pH, usually 6.98–7.25.

   Increased serum potassium, often 6–7 mmol/L.

   Serum chloride normal or low with increased AG.