Imperatively, when weighing a metabolic acidosis diagnosis, the change in serum bicarbonate levels over time should be considered if baseline bicarbonate results are unknown, a single set of values may be misinterpreted. In the absence of chronic respiratory alkalosis, metabolic acidosis can be clinically diagnosed by measuring serum bicarbonate levels in the blood, which is generally a standard component of blood panels. Metabolic acidosis is defined as a reduced serum pH, and an abnormal serum bicarbonate concentration of <22 mEq/L, below the normal range of 22 to 29 mEq/L. However, if a patient has other coexisting acid-base disorders, the pH level may be low, normal or high in the setting of metabolic acidosis. Patients with CKD Stages G3-G5 should be routinely screened for metabolic acidosis. Cranial nerve abnormalities are reported in ethylene glycol poisoning, and retinal edema can be a sign of methanol intoxication.Ĭhronic metabolic acidosis has non-specific clinical symptoms but can be readily diagnosed by testing serum bicarbonate levels in patients with Chronic Kidney Disease (CKD) as part of a comprehensive metabolic panel. Physical examination can occasionally reveal signs of the disease, but is often otherwise normal.
Cardiac: Abnormal heart rhythms (e.g., ventricular tachycardia) and decreased response to epinephrine, both leading to low blood pressure. Neurological: lethargy, stupor, coma, seizures. Overcompensation via respiratory alkalosis to form an alkalemia does not occur.Įxtreme acidemia can also lead to neurological and cardiac complications: Rapid deep breaths increase the amount of carbon dioxide exhaled, thus lowering the serum carbon dioxide levels, resulting in some degree of compensation. People with acute metabolic acidosis may exhibit deep, rapid breathing called Kussmaul respirations which is classically associated with diabetic ketoacidosis. Symptoms may include palpitations, headache, altered mental status such as severe anxiety due to hypoxia, decreased visual acuity, nausea, vomiting, abdominal pain, altered appetite and weight gain, muscle weakness, bone pain, and joint pain. Symptoms are not specific, and diagnosis can be difficult unless patients present with clear indications for arterial blood gas sampling. Signs and symptoms Acute metabolic acidosis The adverse effects of acute versus chronic metabolic acidosis also differ, with acute metabolic acidosis impacting the cardiovascular system in hospital settings, and chronic metabolic acidosis affecting muscles, bones, kidney and cardiovascular health. A state of chronic metabolic acidosis, lasting several weeks to years, can be the result of impaired kidney function ( chronic kidney disease) and/or bicarbonate wasting. Acidemia and acidosis are not mutually exclusive – pH and hydrogen ion concentrations also depend on the coexistence of other acid-base disorders therefore, pH levels in people with metabolic acidosis can range from low to high.Īcute metabolic acidosis, lasting from minutes to several days, often occurs during serious illnesses or hospitalizations, and is generally caused when the body produces an excess amount of organic acids ( ketoacids in ketoacidosis, or lactic acid in lactic acidosis). Metabolic acidosis can lead to acidemia, which is defined as arterial blood pH that is lower than 7.35. Metabolic acidosis has three main root causes: increased acid production, loss of bicarbonate, and a reduced ability of the kidneys to excrete excess acids. Metabolic acidosis is a serious electrolyte disorder characterized by an imbalance in the body's acid-base balance. Ĭhronic: Highly prevalent in people with Chronic Kidney Disease: 9.4% CKD Stage 3a 18.1% CKD Stage 3b 31.5% CKD Stage 4 and 5 Level of bicarbonate (HCO3-) in the bloodĬhronic: Diet rich in fruits and vegetables, oral alkali therapy Īcute: Most often presented during critical illnesses, and hospitalizations: incidence ranging from 14-42%. 
Bicarbonate measurements are part of routine metabolic panels.Īcute: poor morbidity and mortality outcomes Ĭhronic: adverse outcomes on kidney function, musculoskeletal system, possible cardiovascular effectsĪcute: Excessive amounts of organic acids The level of bicarbonate in the blood (HCO 3 −) determines the severity of acidosis.
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