Causes and treatment of metabolic acidosis

In the metabolic acidosis there is a reduction in the concentration of bicarbonate and, therefore, an acidification of the pH of the blood. This reduction is associated with a compensating decrease in the partial pressure of carbon dioxide.

It is a disorder of the acid-base balance of the organism. It affects the normal acid-base balance and causes, as a consequence, a deviation of the pH of the blood. There are several levels of severity, some of which may result in the death of the patient.

Definitely, Metabolic acidosis is a disorder of the acid-base balance that is characterized by the lowering of the pH of the blood, a decrease in carbon dioxide levels and a picture of hyperventilation as a compensating mechanism.


Typically, the onset of metabolic acidosis be by more than one mechanism at the same time. Among them, you can give the following:

  • Excessive contribution or excessive endogenous production of non-volatile acids. For example, when there is diabetic ketoacidosis, lactic acidosis or acidosis produced by the supply of acid precursors.
  • Alteration of the regeneration of bicarbonate by the kidneys (acidosis in acute or chronic renal failure) or alteration of proton excretion in the distal tubules (distal tubular acidosis).
  • Loss of basic substances: this loss can occur at the renal level or in the digestive tract.

Metabolic acidosise can compensate by respiratory route, that is, through hyperventilation. Thanks to it, the partial pressure of carbon dioxide decreases and the blood pH is partially or completely normalized.

What are the symptoms of metabolic acidosis?

Symptoms of a metabolic acidosis are not specific. It is for this reason that the diagnosis can be complicated, unless the patient presents clear indications for the sampling of gases in the arterial blood.

The symptoms that these patients suffer include:

  • Chest pain.
  • Palpitations
  • Headache.
  • Alteration of the mental state: includes severe anxiety due to hypoxia, decreased visual acuity, nausea, vomiting, abdominal pain, appetite disturbance and weight loss.

Those who are in a situation of metabolic acidosis they usually present breathing that is known as Kussmaul's breathing. This type of breathing is characterized by being deep, fast and associated with classic diabetic ketoacidosis.

Read also: Diagnosis and treatment of diabetes insipidus

On the other hand, extreme acidemia leads to complications neurological and cardiac:

  • Neurological: lethargy, stupor, coma and convulsions.
  • Cardiac: arrhythmias and decreased response to epinephrine can occur. Both situations lead to arterial hypotension.
  • Serious metabolic acidosis it can lead to shock or death.


These exams can help diagnose acidosis. They can also determine if the cause is a respiratory problem or a metabolic problem. Tests may include:

  • Arterial blood gases.
  • Basic metabolic panel: This is a set of blood tests that measure sodium and potassium levels, kidney function and other chemicals and functions.
  • pH of the urine.
  • Centones in the urine and in the blood.
  • Lactic acid test.
  • Others.

What treatment is used in case of metabolic acidosis?

The treatment is intended to treat the cause that triggers the disorder. Patients with renal failure require hemodialysis, which is sometimes also used for individuals with ethylene glycol, methanol and salicylate poisoning.

In cases of severe academia, bicarbonate is usually administered of sodium, but it should be done with caution because in some circumstances it is harmful.

When the metabolic acidosis is secondary to the loss of bicarbonate ions or the accumulation of inorganic acids, treatment with bicarbonate is usually safe and appropriate.

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But nevertheless, When the acidosis is due to the accumulation of organic acids, this type of therapy is controversial, given that it does not significantly reduce mortality rates under these conditions and may be associated with some risks.

Despite these and other controversies, Most experts still recommend the intravenous administration of bicarbonate in severe metabolic acidosis, which is one that has pH values ​​below 7.1.