09 Feb Metabolic acidosis
Lactic vs Keto Acidiosis
How Metabolic Acidosis Happens?
Metabolic acidosis happens when the chemical balance of acids and bases in your blood gets thrown off. Your body:
- Is making too much acid
- Isn’t getting rid of enough acid
- Doesn’t have enough base to offset a normal amount of acid
When any of these happen, chemical reactions and processes in your body don’t work right.
Although severe episodes can be life-threatening, sometimes metabolic acidosis is a mild condition. You can treat it, but how depends on what’s causing it.
Causes of Metabolic Acidosis
Different things can set up an acid-base imbalance in your blood.
Ketoacidosis. When you have diabetes and don’t get enough insulin and get dehydrated, your body burns fat instead of carbs as fuel, and that makes ketones. Lots of ketones in your blood turn it acidic. People who drink a lot of alcohol for a long time and don’t eat enough also build up ketones. It can happen when you aren’t eating at all, too.
Lactic acidosis. The cells in your body make lactic acid when they don’t have a lot of oxygen to use. This acid can build up, too. It might happen when you’re exercising intensely. Big drops in blood pressure, heart failure, cardiac arrest, and an overwhelming infection can also cause it.
Renal tubular acidosis. Healthy kidneys take acids out of your blood and get rid of them in your pee. Kidney diseases as well as some immune system and genetic disorders can damage kidneys so they leave too much acid in your blood.
Metabolic acidosis develops when too much acid is produced in the body. It can also occur when the kidneys cannot remove enough acid from the body.
There are several types of metabolic acidosis:
- Diabetic acidosis (also called diabetic ketoacidosis and DKA) develops when substances called ketone bodies (which are acidic) build up during uncontrolled diabetes.
- Hyperchloremic acidosis is caused by the loss of too much sodium bicarbonate from the body, which can happen with severe diarrhea.
- Kidney disease (uremia, distal renal tubular acidosis or proximal renal tubular acidosis).
- Lactic acidosis.
- Poisoning by aspirin, ethylene glycol (found in antifreeze), or methanol.
- Severe dehydration.
Lactic acidosis results from a buildup of lactic acid. Lactic acid is mainly produced in muscle cells and red blood cells. It forms when the body breaks down carbohydrates to use for energy when oxygen levels are low. It can be caused by:
- Carbon monoxide poisoning
- Drinking too much alcohol
- Exercising vigorously for a very long time
- Liver failure
- Low blood sugar (hypoglycemia)
- Medicines, such as salicylates, metformin, anti-retrovirals
- MELAS (a very rare genetic mitochondrial disorder that affects energy production)
- Prolonged lack of oxygen from shock, heart failure, or severe anemia
Most symptoms are caused by the underlying disease or condition that is causing the metabolic acidosis. Metabolic acidosis itself most often causes rapid breathing. Acting confused or very tired may also occur. Severe metabolic acidosis can lead to shock or death. In some situations, metabolic acidosis can be a mild, ongoing (chronic) condition.
Although symptoms can differ, someone with metabolic acidosis will often:
- Breathe fast
- Have a fast heartbeat
- Have a headache
- Be confused
- Feel weak
- Feel tired
- Have little desire to eat
- Feel sick to their stomach
- Throw up
Fruity-smelling breath is a classic symptom of diabetic ketoacidosis (DKA).
If you have these symptoms, call your doctor. You’ll probably need to go to the hospital if they’re severe.
Exams and Tests
These tests can help diagnose acidosis. They can also determine whether the cause is a breathing problem or a metabolic problem. Tests may include:
- Arterial blood gas
- Basic metabolic panel, (a group of blood tests that measure your sodium and potassium levels, kidney function, and other chemicals and functions)
- Blood ketones
- Lactic acid test
- Urine ketones
- Urine pH
Other tests may be needed to determine the cause of the acidosis.
Tests can help your doctor figure out what’s going on in your body so that you get the right treatment.
Anion gap. This test measures the chemical balance in your blood. It compares the numbers of positively and negatively charged particles, including sodium, chloride, and bicarbonate. Certain types of metabolic acidosis have a bigger difference — or “gap” — than others.
Arterial blood gases. This test measures the pH of your blood and the levels of oxygen and carbon dioxide in it.
Urine tests can reveal ketoacidosis, kidney problems, and poisoning from alcohol, aspirin, and antifreeze. If you have diabetes, you can test your pee for ketones at home with test strips you can buy over the counter.
Some blood sugar meters can measure ketones in your blood.
Treatment is aimed at the health problem causing the acidosis. In some cases, sodium bicarbonate (the chemical in baking soda) may be given to reduce the acidity of the blood. Often, you will receive lots of fluids through your vein.
You treat metabolic acidosis by treating what’s causing it. If you don’t restore the balance, it can affect your bones, muscles, and kidneys. In severe cases, it can cause shock or death. DKA can put you in a coma.
- Detoxification, if you have drug or alcohol poisoning
- Insulin, if you have DKA
- IV fluids, given by needle through a vein in your arm
- Sodium bicarbonate, by IV
You might have to go to a hospital.
You can’t always prevent metabolic acidosis, but there are things you can do to lessen the chance of it happening.
Drink plenty of water and non-alcoholic fluids. Your pee should be clear or pale yellow.
Limit alcohol. It can increase acid buildup. It can also dehydrate you.
Manage your diabetes, if you have it.
Follow directions when you take your medications.
The outlook will depend on the underlying disease causing the condition.
Very severe metabolic acidosis can lead to shock or death.
When to Contact a Medical Professional
Seek medical help if you have symptoms of any disease that can cause metabolic acidosis.
Diabetic ketoacidosis can be prevented by keeping type 1 diabetes under control.
Acidosis – metabolic