Metabolic Acidosis: What It Is, Symptoms and Treatment

Blood acidosis is characterized by excess acidity, causing a pH below 7.35, which is usually caused as follows:

  • Metabolic acidosis : loss of bicarbonate or accumulation of some acid in the blood;
  • Respiratory acidosis : accumulation of carbon dioxide (CO2) in diseases that affect breathing, diarrhea, kidney disease, generalized infection, heart failure or intoxication due to the use of acidic substances.

The normal blood pH should be between 7.35 to 7.45, as this range allows the body’s metabolism to function properly. The acidic pH causes symptoms such as shortness of breath, palpitations, vomiting, drowsiness, disorientation and can even lead to death if it is not treated immediately.

In addition to acidosis, the pH can become more alkaline, above 7.45, which can occur both in metabolic alkalosis and in respiratory alkalosis

1. Metabolic acidosis

Metabolic acidosis is caused by the accumulation of acidity in the bloodstream, either by the loss of bicarbonate or by the accumulation of different types of acid. 

What are the causes

Possible causes of acidity in the blood are the loss of alkaline substances, such as bicarbonate, or the accumulation of acids in the bloodstream, such as lactic acid or acetoacetic acid, for example. Some of the situations that lead to this are;

  • Severe diarrhea;
  • Kidney diseases;
  • Generalized infection;
  • Bleeding;
  • Cardiac insufficiency;
  • Diabetic ketoacid;
  • Intoxication, with AAS, alcohol, methanol or ethylene glycol, for example;
  • Injury to several muscles in the body, which happens in cases of strenuous exercise or in diseases such as leptospirosis, for example.

It is important to remember that another cause of blood acidity is respiratory acidosis, caused by the accumulation of CO2 in the blood due to lung problems, such as severe asthma or emphysema, neurological disease that prevents breathing, such as ALS or muscular dystrophy or any other disease that make breathing difficult.  

Main symptoms

Metabolic acidosis can cause a series of reactions in the body that influence breathing, brain reactions, cardiac function and the body’s metabolism. The main signs and symptoms include:

  • Lack of air;
  • Increased respiratory rate;
  • Palpitations;
  • Nausea and vomiting;
  • Headache;
  • Drowsiness or disorientation;
  • Low pressure;
  • Glucose intolerance.

In some cases, patients with metabolic acidosis may go into a coma and be at risk of death if treatment is not started quickly.

The confirmation of metabolic acidosis is done by an exam called arterial blood gas analysis, capable of obtaining pH values ​​and several other data on arterial blood. Find out more details about this exam at what arterial blood gases are used for . In addition, other tests, such as urine testing or testing for toxics in the blood, can help determine the cause of ketoacidosis.

How to deal with 

The treatment for metabolic acidosis must be carried out at the hospital and, generally, the correction of the disease that causes the acidosis is sufficient to improve the condition, such as the administration of insulin in the case of diabetes, detoxification by toxic substances, for example, in addition to hydration with serum in the vein.

In cases where there is loss of sodium bicarbonate, such as diarrhea or vomiting, replacement of this substance by oral route may be indicated. However, in some cases of severe metabolic acidity, the administration of bicarbonate in the vein may be necessary to decrease acidity more quickly. 

2. Respiratory acidosis

Respiratory acidosis is the excess of acidity in the blood that happens due to decreased ventilation in the lungs due to breathing difficulties, which leads to an increase in the concentration of carbon dioxide (CO2) in the bloodstream.

What are the causes

Generally, respiratory acidosis is caused by lung diseases such as severe asthma or emphysema, as well as other diseases that can prevent breathing, such as amyotrophic lateral sclerosis, myasthenia gravis, muscular dystrophy, heart failure or when there is a cardiorespiratory arrest, for example. 

Main symptoms

Although it does not always cause symptoms, respiratory acidosis can cause shortness of breath, sweat, dizziness, purplish extremities, coughing, fainting, palpitations, tremors or convulsions, for example.

To confirm the diagnosis, an arterial blood gas test is also performed, which detects the values ​​of blood pH and dosage of substances such as CO2 and bicarbonate, and in addition the doctor will also make a clinical evaluation to identify the cause. 

How to deal with

The treatment of respiratory acidosis is done in an attempt to improve the patient’s breathing, either with lung treatments, use of oxygen or even the use of mechanical ventilation devices in the most severe cases. 

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