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Generally, metabolic acidosis occurs when the body produces too much acid (e.g., lactic acidosis, see below section), there is a loss of bicarbonate from the blood, or when the kidneys are not removing enough acid from the body.
Chronic metabolic acidosis is most often caused by a decreased capacity of the kidneys to excrete excess acids through ammoniagenesis. The typical Western diet generates 20-30 mEq of acid daily{{citation needed}}, and individuals with normal kidney function increase the production of ammonia to get rid of this dietary acid. As kidney function declines, the tubules lose the ability to excrete excess acid, and this results in buffering of acid using serum bicarbonate, as well as bone and muscle stores.<ref>{{Cite web|url=https://www.uptodate.com/contents/pathogenesis-consequences-and-treatment-of-metabolic-acidosis-in-chronic-kidney-disease|title=Pathogenesis, consequences, and treatment of metabolic acidosis in chronic kidney disease|last=Kovesdy|first=Csaba|website=UpToDate}}</ref>
There are many causes of acute metabolic acidosis, and thus it is helpful to group them by the presence or absence of a normal anion gap.<ref>{{Cite book|title=Symptom to diagnosis: an evidence-based guide|url=https://accessmedicine.mhmedical.com/book.aspx?bookID=1088|url-access=subscription|last1=Stern|first1=Scott D. C.|last2=Cifu|first2=Adam S.|last3=Altkorn|first3=Diane|isbn=9780071803441|edition= 3rd|location=New York|publisher=[[McGraw-Hill Education]]|date=2015|oclc=896866189}}</ref>
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