Metabolic acidosis

Metabolic acidosis
The calculated level of bicarbonate in the blood (HCO3−) reflects the severity of acidosis.
Specialty	Nephrology
Complications	Acute: poor morbidity and mortality outcomes; Chronic: adverse outcomes on kidney function, musculoskeletal system, possible cardiovascular effects
Types	Acute Metabolic Acidosis Chronic Metabolic Acidosis
Causes	Acute: Excessive amounts of organic acids; Chronic: Impaired kidney function
Diagnostic method	Level of bicarbonate (HCO3-) in the blood
Treatment	Acute: Mitigation of the underlying cause for the metabolic problem, such as administration of insulin in cases of diabetic ketoacidosis or restoration of effective circulating intravascular volume in cases of lactic acidosis. The administration of IV bicarbonate, although intellectually appealing, is rarely indicated or administered Chronic: Diet rich in fruits and vegetables, oral alkali therapy[1]
Frequency	Acute: Most often presented during critical illnesses, and hospitalizations: incidence ranging 14–42%.[2][3] Chronic: 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 [4]

Metabolic acidosis is a serious electrolyte disorder characterized by an imbalance in the body's acid-base balance. Metabolic acidosis has three main root causes: increased acid production, loss of bicarbonate, and a reduced ability of the kidneys to excrete excess acids.^[5] Metabolic acidosis can lead to acidemia, which is defined as arterial blood pH that is lower than 7.35.^[6] 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.

Acute 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). 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. 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.^[7]