A metabolic acidosis occurs when the blood becomes too acidic due to an excess of acid or a loss of base. It can cause many symptoms, including rapid breathing, confusion, fatigue, and nausea. In addition to serious complications like coma and organ failure, metabolic acidosis can also be caused by kidney disease, diabetes, poisoning, or dehydration. Treatment depends on the severity of the condition and the underlying cause. Prevention involves avoiding or managing the risk factors and seeking medical attention if necessary.
Various factors can affect the acid-base balance of the body, causing metabolic acidosis. Some of the most common causes include:
A damaged or failing kidney prevents the kidneys from filtering excess acid and maintains a normal pH. When the kidneys are damaged or fail, the acid accumulates in the blood and becomes dangerous. Chronic conditions, such as glomerulonephritis, polycystic kidney disease, or diabetic nephropathy, as well as acute conditions, such as kidney injury, infection, or obstruction, can cause this.
Due to a lack or resistance to insulin, diabetes is a condition in which the body cannot use glucose (sugar) for energy. As a result, the body breaks down fats and proteins for energy, producing ketones as a by-product. Ketones are acidic and can lower blood pH. Type 1 diabetes is caused by an autoimmune destruction of insulin-producing cells in the pancreas, while type 2 diabetes is caused by factors such as genetics and lifestyle.
When a substance is ingested, inhaled, injected, or absorbed, it causes poisoning. As a result of interfering with the normal metabolism of cells or by producing acid as a by-product, some poisons can cause metabolic acidosis. A number of poisons can cause metabolic acidosis, including ethanol, methanol, ethylene glycol, salicylates, and cyanide.
When the body loses water and electrolytes (minerals) as a result of excessive sweating, vomiting, diarrhea, or fever, it is called dehydration. By reducing fluid in the blood and increasing acid concentrations, dehydration can result in metabolic acidosis. As the kidneys and lungs regulate the acid-base balance, dehydration can also adversely affect their function.
Metabolic acidosis symptoms vary depending on the cause, severity, and duration of the condition. However, some of the common symptoms include:
As a compensatory mechanism, rapid and deep breathing (Kussmaul breathing) aims to expel excess carbon dioxide (CO2) from the lungs and increase blood pH.
Acid can impair cognitive and mental functions, leading to confusion and lethargy.
It is caused by the reduced oxygen delivery to the tissues as well as the impaired cellular metabolism, which can negatively affect energy production and muscle function.
The brain and gastrointestinal tract are stimulated, causing nausea and vomiting as a way of removing the acid from the body.
Dilation of the blood vessels and inflammation of the organs can cause headaches and abdominal pain.
It is necessary for a doctor to perform a physical examination and ask about the patient's medical history and symptoms in order to diagnose metabolic acidosis. In addition to the blood and urine tests, the doctor will order certain tests to measure pH, acidity, base, and electrolytes. Some of these tests include:
In a blood sample, the arterial blood gas (ABG) is measured as a pH, partial pressure of oxygen (PaO2), partial pressure of carbon dioxide (PaCO2), and bicarbonate (HCO3) concentration. A low pH (< 7.35), a low PaCO2 (< 35 mmHg), and a low HCO3 (< 22 mEq/L) indicate metabolic acidosis.
The serum electrolytes test measures electrolytes in the blood such as sodium (Na), potassium (K), chloride (Cl), and bicarbonate (HCO3). A low HCO3 level ( 22 mEq/L) and a high Cl level (> 105 mEq/L) indicate metabolic acidosis.Blood electrolytes: This test measures the levels of sodium (Na), potassium (K), chloride (Cl), and bicarbonate (HCO3) in the blood. Low HCO3 (> 22 mEq/L) and high Cl (> 105 mEq/L) indicate metabolic acidosis.
It measures how much positively charged ions (cations) and negatively charged ions (anions) in blood differ from one another. It is normal for an anion gap to be between 8 and 16 milliEq/L. High anion gaps (> 16 milliEq/L) indicate metabolic acidosis caused by an accumulation of organic acids, such as lactate or ketones. Diabetic acidosis or renal tubular acidosis are examples of metabolic acidosis caused by the loss of bicarbonate.
An acidic urine or ketones test measures the urine's acidity or ketones. Diabetes or starvation can cause metabolic acidosis if the urine pH is below 5.5 and the ketone test is positive. Metabolic acidosis can result from renal failure or poisoning if the urine pH is high (> 5.5) and the ketone test is negative.
Depending on the cause, severity, and complications of metabolic acidosis, the condition may require a variety of treatment options. Among the treatment options are: correcting the acid-base imbalance, addressing the underlying causes, and preventing or managing complications.
In order to restore hydration as well as normal sodium, potassium, chloride, and bicarbonate levels in the blood, fluid and electrolyte replacement is given intravenously (in a vein). As a result, kidney function and acid excretion can be improved, and dehydration and shock symptoms can be reduced.
To neutralize excess acid and reduce the symptoms of acidosis, bicarbonate administration involves giving it intravenously or orally to increase the blood pH and bicarbonate level. However, this treatment is not recommended for all cases of metabolic acidosis, as it may have side effects or complications, such as fluid overload, hypokalemia (low potassium), and paradoxical acidosis (high acid level in the tissues).
In dialysis, excess acids, waste products, and fluids are removed from the body using a machine. As a result, kidney function and acid-base balance can be improved, and symptoms of acidosis and uremia (high blood levels of urea) can be reduced. In severe cases of metabolic acidosis, such as kidney failure or poisoning, this treatment is usually reserved.
Treatments that target the specific cause of metabolic acidosis include:
Glucose and insulin for diabetic ketoacidosis
Septic shock is treated with antibiotics and drainage
Poisoning antidotes and supportive care
Hypoxia (low oxygen): oxygen and ventilation
There are some steps that can be taken to reduce the risk or severity of metabolic acidosis, such as:
Preventing or limiting exposure to substances that can cause acidosis, such as alcohol, aspirin, antifreeze, or methanol
Maintaining a healthy lifestyle and managing chronic conditions that cause acidosis, such as diabetes, kidney disease, and liver disease
If you experience symptoms of acidosis, such as rapid breathing, confusion, fatigue, or nausea, seek medical attention right away
People with kidney disease, diabetes, or a history of poisoning should monitor their blood pH and electrolyte levels regularly
