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Hidden Signs of Acute Metabolic Acidosis: Can You Recognize the Symptoms?
Metabolic acidosis is a severe electrolyte imbalance characterized by an upset in the body's acid-base balance. There are three main underlying causes of metabolic acidosis: overproduction of acid, loss of bicarbonate, and a reduced ability of the kidneys to excrete the excess acid. This condition may lead to acidosis, which is a state in which the arterial blood pH falls below 7.35. It is important to note that acidosis and acidemia are not mutually exclusive, as pH and hydrogen ion concentration also depend on the presence of other acid-base disorders; therefore, the pH in patients with metabolic acidosis can vary from low to high. .
Acute metabolic acidosis often occurs during critical illness or hospitalization and is generally caused by the body's overproduction of organic acids, such as ketoacids or lactic acid.
For acute metabolic acidosis, the symptoms are nonspecific and diagnosis may be difficult unless the patient has a clear indication for blood gas analysis. Typical symptoms include palpitations, headache, changes in mental status (such as severe anxiety due to lack of oxygen), vision loss, nausea, vomiting, abdominal pain, changes in appetite and weight gain, muscle weakness, and bone and joint pain. In particular, patients with acute metabolic acidosis may develop a deep, rapid breathing pattern called Kussmaul breathing, which is often associated with diabetic ketoacidosis. Deep and rapid breathing can increase the amount of carbon dioxide expelled, thereby lowering serum carbon dioxide levels to achieve some degree of compensation.
Extreme acidemia may also lead to neurologic and cardiac complications, including lethargy, coma, seizures, cardiac abnormalities (such as ventricular tachycardia), and decreased response to adrenaline, ultimately leading to hypotension.
Differences between acute and chronic metabolic acidosis
In contrast to acute metabolic acidosis, chronic metabolic acidosis is caused by impaired renal function (such as chronic kidney disease) or bicarbonate loss. Symptoms of chronic metabolic acidosis are also nonspecific, but diagnosis can be made by measuring serum bicarbonate levels. Patients with chronic kidney disease should be screened regularly for metabolic acidosis.
The diagnosis of metabolic acidosis includes a decrease in serum pH, which is usually due to metabolic rather than respiratory dysfunction. Typically, serum bicarbonate concentrations will fall below 22 mEq/L, and pCO2 will be reduced by hyperventilation in an attempt to restore pH to normal levels. In some cases of mixed acid-base disorders, the pH may be normal or elevated, requiring further testing to confirm that metabolic acidosis is the primary disorder.
Causes of Metabolic AcidosisTypically, metabolic acidosis occurs when the body produces too much acid (for example, lactic acidosis), loses bicarbonate from the blood, or the kidneys are unable to effectively eliminate the excess acid. The most common cause of chronic metabolic acidosis is a decrease in the kidneys' ability to eliminate excess acid. Because a typical Western diet produces 75–100 mEq of acid per day, individuals with normal renal function increase ammonia production to excrete this dietary acid. However, as renal function declines, the renal tubules lose the ability to excrete excess acid, resulting in serum bicarbonate being used to buffer acid and depleting bone and muscle reserves.
In acute metabolic acidosis, causes of increased anion gap include lactic acidosis, ketoacidosis (eg, due to diabetes, alcohol, or starvation), and chronic renal failure.
Diagnosis and treatment
Treatment of metabolic acidosis depends primarily on the underlying cause, with reversal of the primary process causing the acidosis being a priority. It is important to distinguish between acute and chronic metabolic acidosis when considering treatment options. For acute metabolic acidosis, bicarbonate is usually administered when the pH is below 7.11, whereas for milder acidosis (pH between 7.1 and 7.2), it is only given when severe acute kidney injury is present. treat. The goal of treatment is to improve the patient's survival rate and quality of life.
For patients with chronic kidney disease, treating metabolic acidosis can slow disease progression, and dietary interventions, usually with oral bicarbonate, can also help.
However, the side effects of oral bicarbonate include gastrointestinal intolerance, increased edema, and increased hypertension, and large doses of oral alkali therapy may affect patient compliance. Recent studies have shown that an experimental drug called Veverimer effectively and safely improves metabolic acidosis in patients with chronic kidney disease and helps improve their quality of life in the long term.
The diagnosis and treatment of metabolic acidosis requires rapid and correct identification of symptoms. So, what seemingly ignored health signs around you may be the precursors of metabolic acidosis?
