A normal anion gap metabolic acidosis is caused by the loss of bicarbonate with a reciprocal increase in chloride concentration. It is also known as hyperchloremic acidosis. It most commonly results from abnormal gastrointestinal or renal losses of HCO3-. Diarrhea is the most common cause of hyperchloremic metabolic acidosis. Cholera is associated with massive diarrhea. This diarrheal fluid consist of small bowel, biliary, and pancreatic fluids which contains 20-50 mEq/L of HCO 3 -. This loss of large volumes of fluids lead to hyperchloremic metabolic acidosis. Ref: Harrison's Internal Medicine, 18th Edition, Chapter 47 ; Current Diagnosis & Treatment Emergency Medicine, 7th Edition, Chapter 44