Abstract：
Normal-anion-gap metabolic acidosis (NAGMA) is a common but often under-recognised and poorly understood condition, especially by less-experienced clinicians. In adults, NAGMA might be an initial clue to a more significant underlying pathology, such as autoimmune diseases, hypergammaglobulinemia or drug toxicities. However, identifying the aetiology can be challenging due to the diverse processes involved in the development of acidosis. A better understanding of the pathophysiology of NAGMA can help treating physicians suspect and evaluate the condition early and reach the correct diagnosis. This article provides an overview of renal acid-base regulation, discusses the pathophysiological processes involved in developing NAGMA and provides a framework for evaluation to reach an accurate diagnosis.
摘要：
正常阴离子间隙代谢性酸中毒（NAGMA）是一种常见但往往认识不足和知之甚少的疾病，尤其是经验较少的临床医生。在成年人中,NAGMA可能是更重要的潜在病理的初步线索，比如自身免疫性疾病，高丙种球蛋白血症或药物毒性。然而,由于酸中毒的发展涉及多种过程，因此确定病因可能具有挑战性。更好地了解NAGMA的病理生理学可以帮助医生早期怀疑和评估病情并达到正确的诊断。本文概述了肾酸碱调节，讨论了发展NAGMA所涉及的病理生理过程，并提供了一个评估框架，以达到准确的诊断。
