There exists a complex regulatory system to regulate the acid-base balance. The diagnosis of metabolic acidosis should always triger search for the underlying cause, guided by the clinical context. Anion gap is helpful when assessing the underlying cause of metabolic acidosis. Lack of evidence in the case of treating acidemia with buffering therapy complicates decision making on bicarbonate administration. However, the key to the treatment of metabolic acidosis is treating the underlying pathology, and active search for a correct or adequate diagnosis should be a priority. An approach to metabol ic acidosis is presented in a summarised form in the table below.