Metabolic acidosis is a clinical condition which occurs when the body begins to produce excess amount of acid or the kidneys do not excrete acid as it should do from the body. Metabolic acidosis usually develops due to an underlying health condition. Maintaining a balance between acid and alkalinity in plasma and body fluids is vital for functioning of the tissues. When this balance is disturbed, it can produce metabolic acidosis.
Metabolism is a process in the body which provides energy to sustain life in the body. If metabolic activity is disturbed due to underlying health condition, it can result in concentration of H+ ions in the body.The H+ ions are acidic, therefore excess of H+ ion leads to high level of acidity in the body fluids.
Measure of acidity or alkalinity of fluids is expressed numerically as pH. In metabolic acidosis the pH is low, <7.35. Metabolic acidosis can be serious to life, but in many cases it can be mild. Treatment depends on the etiology, acuteness and severity of acidosis.
Cause Of Metabolic Acidosis
There are many factors associated with metabolic acidosis. The imbalance between acid and base in blood and body fluid can result from following:
- Ketoacidosis: Ketoacidosis results when excess of fat is used as an energy source instead of carbohydrate by the body. This increased utilization of fat precipitates ketones in the body which in turn makes the blood and body fluids acidic. Ketoacidosis is commonly seen in diabetics with absolute deficiency of insulin, where energy requirement are met from fats. Similar is the case with starvation when the carbohydrate stores in the body are exhausted. Chronic alcoholics suffer from ketoacidosis when they fore go meals for a long period of time.
- Lactic acidosis: Lactic acid is produced by red blood cells, heart muscles and skeletal muscles of the body particularly during exercise. Most of the lactic acid produced normally is utilized by the liver for further process of energy production. Lactic acidosis occurs in overproduction, liver dysfunction or impaired renal capacity to buffer and excretes acid. Lactic acidosis mainly occurs due to lack of oxygen supply to the tissues. It occurs in heart attack where the cardiac muscles are damaged. It also occurs in cases of shock due to septicemia and hemorrhage.
- Renal acidosis: Normally acid is flushed out from the blood by the kidney through urine. Chronic renal failure can cause acid retention and excess built up in the blood.
- Low alkalinity: Certain condition such as diarrhea, vomiting and laxative abuse can result in low level of bicarbonates in the blood. Bicarbonate is alkaline in nature and it helps in buffering of acid. Low bicarbonate level naturally causes increased acidity in the body.
Symptoms Of Metabolic Acidosis
Often the symptoms of metabolic acidosis vary from patient to patient as it depends on underlying disease. However, the most common symptoms are as follows:
Hyperventilation with deep and rapid breathing is characteristic symptom of acute metabolic acidosis. Such type of breathing in medical terminology is called Kussmaul breathing. Besides this in more severe cases of keto and lactic acidosis there may be confusion, drowsiness, stupor and coma. Fruity smelling breath is classical finding of diabetic keto -acidosis.
Although chronic metabolic acidosis exerts many effects on body tissue, the clinical manifestation are non specific. The heart rate and rhythm may be disturbed. It may also affect the bones leading to osteoporosis. Clinical manifestations of chronic metabolic acidosis are:
- Rapid breathing
- Patient is unable to do slightest physical effort
- Bone pain
- Less appetite
- Diarrhea and vomiting
- Abdominal discomfort
- Low blood pressure
Treatment For Metabolic Acidosis
Diagnosis of metabolic acidosis depends on high index of suspicion from the clinical symptoms and medical history. For example the symptoms may be suspected to those of acidosis if patient is diabetic or is starving for long time. Other laboratory tests then specifically help in identifying the condition.
- Metabolic acidosis requires hospital treatment.
- The treatment of metabolic acidosis is based on the underlying cause that is responsible for it. In case of acute form of acidosis which is often associated with loss of fluid and electrolyte, replenishing both of them in time will be beneficial for the patient.
- Diabetic ketoacidosis is primarily treated with insulin administration and repletion of fluid.
- Alcoholic ketoacidosis can be controlled by intravenous fluids as the doctor recommends during that period.
- Lactic acidosis needs prompt administration of fluid containing sodium bicarbonate.