Metabolic Acidosis (MA)
Metabolic Acidosis (MA): Causes, Symptoms, Diagnosis, and Treatment
Metabolic acidosis (MA) is a life-threatening electrolyte disorder characterized by an excess of acid in the bloodstream, leading to a blood pH below 7.35. It arises from increased acid production, loss of bicarbonate, or impaired renal excretion of acids.
Causes of Metabolic Acidosis
Metabolic acidosis is classified by its anion gap (AG) and underlying mechanisms:
| Type | Examples |
|---|---|
| High Anion Gap | Ketoacidosis (diabetes, alcoholism), lactic acidosis (shock, sepsis), toxins (methanol, ethylene glycol). |
| Normal Anion Gap | Gastrointestinal bicarbonate loss (diarrhea, ileus), renal tubular acidosis, kidney failure (chronic). |
Key Triggers:
- Diabetes: Diabetic ketoacidosis (DKA) due to insulin deficiency.
- Hypoxia: Lactic acidosis from tissue hypoperfusion (e.g., heart failure, sepsis).
- Kidney Disease: Chronic kidney disease (CKD) impairs acid excretion.
- Toxins: Methanol, ethylene glycol, or aspirin poisoning.
Symptoms
Symptoms vary by severity and cause:
- Acute Metabolic Acidosis:
- Respiratory: Kussmaul respirations (deep, rapid breathing).
- Neurological: Confusion, lethargy, seizures, or coma.
- Cardiovascular: Hypotension, arrhythmias (e.g., ventricular tachycardia).
- Gastrointestinal: Nausea, vomiting, abdominal pain.
- Chronic Metabolic Acidosis:
- Muscle weakness, bone pain, or uremic symptoms (e.g., fatigue, edema).
- Fruity breath odor in diabetic ketoacidosis.
Diagnosis
- Blood Tests:
- Arterial blood gas (ABG): pH <7.35, low bicarbonate (HCO₃⁻).
- Anion gap: Calculated as [Na⁺] – ([Cl⁻] + [HCO₃⁻]).
- High AG: >12 mEq/L (e.g., ketoacidosis, toxins).
- Normal AG: ≤12 mEq/L (e.g., diarrhea, kidney disease).
- Imaging:
- CT/MRI: Identifies infection sources (e.g., pneumonia, abscess).
- Clinical Evaluation:
- History: Diabetes, toxin exposure, or kidney disease.
Treatment
Treatment targets the underlying cause and corrects acid-base imbalance:
- Acute Acidosis:
- IV fluids: Restore hydration and perfusion.
- Bicarbonate therapy: Sodium bicarbonate for severe acidemia (pH <7.10).
- Antibiotics: For infections (e.g., sepsis).
- Insulin: For diabetic ketoacidosis.
- Chronic Acidosis:
- Bicarbonate supplements (oral or IV).
- Dialysis: For advanced kidney failure.
- Supportive Care:
- Respiratory support: Ventilation for hyperpnea or respiratory failure.
- Cardiac monitoring: Manage arrhythmias.
Complications
- Cardiac: Arrhythmias, hypotension, or shock.
- Neurological: Coma, seizures, or long-term cognitive impairment.
- Musculoskeletal: Bone demineralization (e.g., osteomalacia).
- Chronic Kidney Disease: Accelerates kidney damage.
Prevention
- Diabetes Management: Avoid hyperglycemia to prevent ketoacidosis.
- Hydration: Prevent dehydration in CKD or diarrhea.
- Avoid Toxins: Limit alcohol, aspirin, or methanol exposure.
Conclusion
Metabolic acidosis is a medical emergency requiring rapid diagnosis and treatment. Identifying the cause—whether high anion gap (e.g., toxins) or normal anion gap (e.g., kidney disease)—guides therapy to restore acid-base balance and prevent fatal complications.
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