Metabolic acidosis is a metabolic state in the body where there is an increase of acid in the body fluids. Metabolic acidosis is also physiologically defined as the primary reduction in HCO3 ion concentration in the blood with a compensatory reduction in PCO2 ion levels while pH remains subnormal.
The following laboratory examinations and tests are utilized for the work up of patients with metabolic acidosis:
The goal in the treatment of metabolic acidosis is to raise the serum pH to more than 7.2 to prevent life-threatening complications like cardiac arrhythmia. The most common drug used to balance metabolic acidosis is sodium bicarbonate . Bicarbonate deficit is generally computed as desired HCO3 is equal to HCO3 deficit per Liter multiplied by 0.5 times body weight.
This computation will give a crude estimate of the HCO3 deficit in serum where sodium bicarbonate is administered intravenously to correct the imbalance. In the same way potassium citrate can also be given to correct metabolic acidosis with hypokalemia. Oral sodium bicarbonate is indicated for metabolic acidosis states that requires exogenous bases or alkalis to correct . Researches have determined that potassium citrate may be superior to sodium bicarbonate because it requires lesser volume and does propagate the unnecessary excretion of calcium ion in the urine .
In general, the prognosis of metabolic acidosis is related to the underlying condition that gave rise to it. Cohort studies have shown that mortality with metabolic acidosis is usually caused by unabated acidotic states from hyperchloremia . Significant morbidity is also observable among patients with uncorrected and late correction of acid-base imbalances from the time of admission. Severe uncorrected metabolic acidosis can lead to shock or death.
Medical conditions that lead to the buildup of acid in the body can potentially cause metabolic acidosis. These medical conditions include:
There are no exact epidemiologic data that give the incidence and prevalence of metabolic acidosis. The relative prevalence of this metabolic state is reflected in each primary disease etiology that result in this acidemic state. Moreover, metabolic acidosis is oftentimes underdiagnosed and underdocumented because metabolic acidosis is just a mere sign of a primary disease process.
In general, the basic pathophysiology of metabolic acidosis is two folds. There could be an increased acid production within any organ system or there is an inadequate production of bicarbonates from the buffering systems of the body . The body regulates plasma acidity by means of these buffering systems: the bicarbonate buffering system, renal compensatory system, respiratory compensatory system, and the intracellular absorption of hydrogen atoms. The bicarbonate system receives the hydrogen from the acidic compounds and neutralizes them into carbon dioxide and water. Any imbalance in the buffering system moves the pH lower than 7.4 making the serum acidic.
Prevention of metabolic acidosis is grossly dependent on the primary prevention of its underlying causes. Diabetic control is essential to prevent diabetic ketoacidosis from ensuing. Alcohol should be taken in moderation to avoid alcoholic ketoacidosis from taking place. Athletic sports and exercises should be done in moderation to prevent lactic acidosis from developing. The injudicious use of salicylate-base pain relievers and iron supplements must be checked to prevent it’s toxicity that may lead to metabolic acidosis.
Metabolic acidosis is defined as a medical condition where there is an imbalance of the acid-base ions causing plasma acidity. The metabolic acidosis state is usually a sign of underlying disease process. Correction of the primary cause of the metabolic imbalance will normalize or reverse the metabolic state. An indepth understanding of the nature of the acid-base regulation mechanism is required to understand the complex processes that give rise to metabolic acidosis.