The nurse is caring for a client who has developed metabolic acidosis and has an anion gap of 12 mEq/L. The nurse informs a family member that this finding indicates that the client's acidosis is caused by
a. accelerated lipid metabolism.
b. an increase of fixed acid.
c. increases in carbonic acid.
d. loss of bicarbonate.
D
When acidosis is the result of the addition of acid, as in lactic acidosis, bicarbonate is consumed (but not lost to the body) in buffering most of the acid load. Unmeasured anions increase in number to maintain electroneutrality, thus increasing the anion gap. But in an acidosis where the anion gap remains normal (12 + 4 mEq/L), the acidosis is caused by a loss of base. Non–anion gap acidosis is also called hyperchloremic metabolic acidosis.
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