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Therefore, sodium Na , the primary plasma cation, is balanced by the sum of the anions bicarbonate and chloride in addition to the unmeasured anions, which represent the anion gap. Unmeasured anions include lactate and acetoacetate, and these are often some of the main contributors to metabolic acidosis. Anion gap metabolic acidosis is frequently due to anaerobic metabolism and lactic acid accumulation. While lactate is part of many mnemonics for metabolic acidosis, it is important to distinguish it is not a separate etiology, but rather a consequence of a condition.
Non-gap metabolic acidosis is primarily due to the loss of bicarbonate, and the main causes of this condition are diarrhea and renal tubular acidosis. GI and renal losses of bicarbonate can be distinguished via urine anion gap analysis:. A positive value is indicative of renal bicarbonate loss, such as renal tubular acidosis. Negative values are found with non-renal bicarbonate losses, such as diarrhea. Metabolic acidosis is a sign of underlying pathology, and while it is not uncommon, especially in acutely ill patients, the overall prevalence in the population is uncertain.
Hydrogen ion concentration is determined by acid ingestion, acid production, acid excretion, and renal and GI bicarbonate losses. Buffers such as bicarbonate minimize significant pH alterations. A focused history can elicit potential causes of acid-base disturbances such as vomiting, diarrhea, medications, possible overdoses and chronic conditions with a predisposition to acidosis including diabetes mellitus.
The physical exam reveals signs unique to each cause such as dry mucous membranes in the patient with diabetic ketoacidosis. Hyperventilation may also be present as a compensatory respiratory alkalosis to assist with PCO2 elimination and correction of the acidemia.
Compensatory reactions do not completely correct a disturbance to the normal pH range, however. Acid-base interpretation is crucial to identify and correct disturbances in acid-base equilibrium that have profound consequences on patient health.
The following steps use lab values and equations to determine if a patient has metabolic acidosis and any additional acid-base disturbances. Blood pH is maintained within a narrow range for optimization of physiological functions. Acid-base equilibrium is achieved within a pH range of 7. Blood pH distinguishes between acidemia pH less than 7. The pCO2 determines whether an acidosis is respiratory or metabolic in origin.
For a respiratory acidosis, the pCO2 is greater than 40 to 45 due to decreased ventilation. Metabolic acidosis is due to alterations in bicarbonate, so the pCO2 is less than 40 since it is not the cause of the primary acid-base disturbance. The normal anion gap is Therefore, values greater than 12 define an anion gap metabolic acidosis.
Respiratory compensation is the physiologic mechanism to help normalize a metabolic acidosis, however, compensation never completely corrects an acidemia. It is important to determine if there is adequate respiratory compensation or if there is another underlying respiratory acid-base disturbance. Winter's formula is the equation used to determine the expected CO2 for adequate compensation. If the pCO2 is greater than expected, this indicates an additional respiratory acidosis.
If the pCO2 is less than expected, there is an additional respiratory alkalosis occurring. The management of metabolic acidosis should address the cause of the underlying acid-base derangement. For example, adequate fluid resuscitation and correction of electrolyte abnormalities are necessary for sepsis and diabetic ketoacidosis.
Your kidney dietitian can show you how to safely increase the right type and amounts of fruits and vegetables in your diet based on your stage of kidney disease. Skip to main content. Metabolic Acidosis. What is metabolic acidosis? What causes metabolic acidosis? What are the signs and symptoms?
Not everyone will have signs or symptoms. What are the complications of metabolic acidosis if I have kidney disease or kidney failure? Increased bone loss osteoporosis : Metabolic acidosis can lead to a loss of bone in your body.
One way to increase bicarbonate levels is through alkali therapy, which could include taking sodium bicarbonate. Your doctor could also suggest taking another similar supplement, such as calcium citrate, calcium carbonate, or calcium acetate. Taking sodium bicarbonate introduces sodium salt into your body.
The problem with this is that most people with later-stage chronic kidney disease have health problems that require them to limit sodium. This includes high blood pressure, heart disease, heart failure, or swelling. In some individuals, using sodium-based supplements could make health problems worse. They may have to take a different type of medication to help instead.
Sometimes there are side effects to sodium bicarbonate, including belching, bloating, flatulence, stomach pain, loss of appetite, feeling sick, and throwing up. For people with metabolic acidosis, making changes in what they eat may help. For example, eating plant-based protein instead of animal-based protein may keep acid levels lower.
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