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The Mystery of Metabolic Acidosis: Do You Know How It Affects Our Health?
Metabolic acidosis is a severe electrolyte imbalance characterized by an imbalance of the acid-base balance in the body. The underlying causes fall into three categories: increased acid production, loss of bicarbonate, and a reduced ability of the kidneys to eliminate excess acid. Metabolic acidosis can lead to acidemia when the blood pH falls below 7.35. It is important to note that acidemia and acidosis are not mutually exclusive. pH and hydrogen ion concentrations are also affected by other acid-base imbalances. Therefore, people with metabolic acidosis may have pH values ranging from low to High and low.
Acute metabolic acidosis usually occurs during severe illness or hospitalization and lasts from minutes to days, while chronic metabolic acidosis can last weeks or even years.
Symptoms of acute metabolic acidosis
The symptoms of acute metabolic acidosis are nonspecific, making diagnosis often difficult. Common symptoms include heart palpitations, headaches, changes in consciousness (such as severe anxiety due to lack of oxygen), vision loss, nausea, vomiting, abdominal pain, changes in appetite and weight, muscle weakness, bone pain, and joint pain. These patients may exhibit rapid, deep breathing known as Kussmaul breathing, a breathing pattern often associated with diabetic ketoacidosis. This breathing pattern increases the amount of exhaled carbon dioxide, thereby lowering serum carbon dioxide concentration in an attempt to restore pH, but excessive respiratory alkalosis does not occur.
Chronic metabolic acidosis
The nonspecific clinical symptoms of chronic metabolic acidosis can be diagnosed by measuring serum bicarbonate levels in patients with chronic kidney disease (CKD). Patients in stages 3 to 5 of CKD should be routinely screened for metabolic acidosis.
Diagnostic methods and causes
The occurrence of metabolic acidosis, which lowers serum pH, is caused by metabolic rather than respiratory dysfunction. Typically serum bicarbonate concentrations will be less than 22 mEq/L, below the normal range of 22 to 29 mEq/L, and the standard base will be more negative than −2. Additionally, pCO2 will decrease due to hyperventilation in an attempt to restore pH to near normal values. In some cases of mixed acid-base imbalance, the pH may be normal or high.
Metabolic acidosis can occur due to too much acid production in the body (such as lactic acidosis) or loss of bicarbonate, or it can be exacerbated by the kidneys' inability to effectively eliminate too much acid.
Pathophysiology
Metabolic acidosis is characterized by low bicarbonate (HCO₃⁻) concentrations, which may be due to increased acid production (such as ketoacids or lactic acids), excessive loss of HCO₃⁻ from the liver, kidneys, or intestines, or a failure to produce it Enough HCO₃ ⁻ caused. The body regulates blood pH through four buffering mechanisms (bicarbonate buffering system, intracellular buffering, respiratory compensation, and renal compensation).
Consequences
Acute metabolic acidosis
Acute metabolic acidosis is most common in hospitalized patients and acute severe cases, and is closely related to poor prognosis. If the pH remains below 7.20, the mortality rate may be as high as 57%.
Chronic metabolic acidosis
Chronic metabolic acidosis commonly occurs in patients with chronic kidney disease (CKD) and can significantly affect cellular function, leading to high patient morbidity. Especially for patients with end-stage renal failure (ESRD), metabolic acidosis can cause serious consequences such as bone loss and muscle atrophy.
Treatment methods
Treatment of metabolic acidosis depends on the underlying cause and should target improvement of the primary process. In patients with acute metabolic acidosis, bicarbonate therapy is usually given if the pH is <7.11 or if there is severe acute kidney injury. For patients with chronic metabolic acidosis, dietary intervention and oral bicarbonate are common treatments. Studies show that bicarbonate supplementation can slow the decline of kidney function and reduce urinary protein.
Veverimer (TRC 101) is currently a promising investigational drug designed to treat metabolic acidosis by binding to acid in the intestine and eliminating it from the body, and its short- and long-term effects have been clinically demonstrated Confirmed in tests.
As the research on metabolic acidosis deepens, understanding its effects and treatment options are crucial to improving patients' quality of life. In your daily life, how can you better pay attention to your acid-base balance and health?
