Metabolic acidosis

  • Definition
    • Metabolic acidosis is a condition in which there is too much acid in the body fluids.

  • Alternative Names
    • Acidosis - metabolic

  • Causes
    • Metabolic acidosis occurs when the body produces too much acid. It can also occur when the kidneys are not removing enough acid from the body.

      There are several types of metabolic acidosis.

      Diabetic acidosis develops when acidic substances, known as ketone bodies, build up in the body. This most often occurs with uncontrolled type 1 diabetes. It is also called diabetic ketoacidosis and DKA.

      Hyperchloremic acidosis results from excessive loss of sodium bicarbonate from the body. This can occur with severe diarrhea.

      Lactic acidosis results from a buildup of lactic acid. It can be caused by:

      Other causes of metabolic acidosis include:

      • Kidney disease (distal renal tubular acidosis and proximal renal tubular acidosis)
      • Poisoning by aspirin, ethylene glycol (found in antifreeze), or methanol
      • Severe dehydration
  • Symptoms
    • Most symptoms are caused by the underlying disease or condition that is causing the metabolic acidosis. Metabolic acidosis itself most often causes rapid breathing. Acting confused or very tired may also occur. Severe metabolic acidosis can lead to shock or death. In some situations, metabolic acidosis can be a mild, ongoing (chronic) condition.

  • Exams and Tests
    • These tests can help diagnose acidosis. They can also determine whether the cause is a breathing problem or a metabolic problem. Tests may include:

      • Arterial blood gas
      • Basic metabolic panel, (a group of blood tests that measure your sodium and potassium levels, kidney function, and other chemicals and functions)
      • Urine pH
      • Urine ketones or blood ketones
      • Lactic acid test
      • Arterial blood gas analysis

      Other tests may be needed to determine the cause of the acidosis.

  • Treatment
    • Treatment is aimed at the health problem causing the acidosis. In some cases, sodium bicarbonate (the chemical in baking soda) may be given to reduce the acidity of the blood. Often, you will receive lots of fluids through your vein.

  • Outlook (Prognosis)
    • The outlook will depend on the underlying disease causing the condition.

  • Possible Complications
    • Very severe metabolic acidosis can lead to shock or death.

  • When to Contact a Medical Professional
    • Seek medical help if you have symptoms of any disease that can cause metabolic acidosis.

  • Prevention
    • Diabetic ketoacidosis can be prevented by keeping type 1 diabetes under control.

  • References
    • Krapf R, Seldin DW, Alpern RJ. Clinical syndromes of metabolic acidosis. In: Alpern RJl, Orson WM, Caplan M, eds. Seldin and Giebisch's The Kidney. 5th ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 59.

      Seifter JL. Acid-base disorders In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 118.