A healthy body maintains a crucial balance between the acids and bases in the blood. But once the body begins to produce too much acid in its body fluids, things get out of control. Metabolic acidosis happens when the body develops too much acid. Read through to learn the causes of acidosis, metabolic acidosis symptoms, and the best way to manage the condition.
What is Metabolic Acidosis?
Acidosis definition marks metabolic acidosis as the build-up of acid in the body. The imbalance can be because of three possible scenarios:
- When the body is not getting rid of enough acid
- When the body produces too much acid
- When the body does not have enough base to neutralise the acid
The condition typically occurs when the kidneys fail to function properly. It can be a mild condition, but if left untreated, it can turn into severe episodes that can be life-threatening.
Causes of Metabolic Acidosis
Metabolic acidosis can be of different types. Each type is fuelled by a different cause. These include:
1. Ketoacidosis
Uncontrolled production of ketones in the body is a cause of Ketoacidosis. Ketones are produced in the body when the body starts burning fats instead of carbohydrates. The overproduction of ketones makes the blood acidic. Untreated diabetes, alcoholism, and starvation are the main reasons that trigger the production of ketones.
2. Lactic Acidosis
When the body does not have enough oxygen to use, it starts producing more lactic acid. A higher concentration of lactic acid in the body makes the blood acidic. This form is typically triggered by an intensive exercise, underlying medical condition, medication, or toxicity.
3. Renal Tubular Acidosis
Kidneys are responsible for filtering blood and getting rid of toxins through urine. But kidney disease and infections can throw the kidneys out of order. Immune system dysfunction and genetic disorders can also damage the kidneys, leading to the accumulation of acid in the blood.
4. Hyperchloremic Acidosis
When the body loses too much sodium bicarbonate from the body, it fails to neutralise the acids in the body. This can happen during severe diarrhoea, laxative abuse, and in people with kidney troubles.
Signs and Symptoms of Metabolic Acidosis
Once the pH balance of the blood begins to drop below the normal mark of 7.35, the body begins to experience changes. Although symptoms can vary, the most common metabolic acidosis symptoms are:
- Fast and rapid breathing
- Rapid heartbeat
- Headache
- Confusion
- Weakness
- Fatigue
- Loss of appetite
- Nausea and vomiting
- Irritability
- Fruity-smelling breath [diabetic ketoacidosis]
Risk Factors for Metabolic Acidosis
Some people are at a higher risk of metabolic acidosis than others. The risk of the condition is more likely in the following cases:
- Intake of a high-fat, low-carb diet
- Kidney failure
- Obesity and overweight
- Dehydration
- Aspirin or methanol abuse
- Diabetes
- Carbon monoxide poisoning
Diagnosis of Metabolic Acidosis
Metabolic acidosis and its degree of severity are diagnosed through blood-based tests. The tests include:
1. Anion Gap
This test is specifically designed to pick up the chemical imbalance in the blood. The imbalance in the blood will indicate if the blood is too acidic or alkaline. The anion gap picks up the difference between positively charged cations of sodium and the negatively charged anions of chloride and bicarbonate in the blood. Anion Gap = [sodium ions – sum of (chloride and bicarbonate ions)].
2. Arterial Blood Gases
The ABG is a blood-based test that measures the level of oxygen and carbon dioxide in the blood. The test also picks up the pH value of the blood.
3. Urine Tests
A urine analysis can help reveal the presence of ketones in the body due to ketoacidosis. The test also helps identify kidney problems and poisoning from alcohol and aspirin.
Metabolic Acidosis Treatment
The metabolic acidosis treatment will depend upon the cause of metabolic acidosis. The treatment typically revolves around easing the symptoms caused by the underlying medical condition.
The treatment for metabolic acidosis usually can work in three ways:
- Helps excrete excess acids
- Infusion of a base to balance blood acidity
- Helping the body halt the production of acids
The main treatments for metabolic acidosis include:
1. Respiratory Compensation
Once the arterial blood gas test will show high levels of carbon dioxide in the blood, a treatment plan which can include bronchodilator medications, steroid drugs, oxygen support, putting on a ventilator machine, use of a breathing machine, and treatment to quit smoking are considered.
2. Diabetes Treatment
Ketoacidosis or metabolic acidosis caused due to diabetes, also known as diabetic ketoacidosis, shows high levels of blood sugar in the blood. This leads to a higher production of ketones that make the blood acidic. The treatment plan includes balancing blood sugar levels and stopping the production of ketones. This is done by insulin infusion, diabetes medication, fluids and restoring electrolyte balance.
3. IV Infusion of Sodium Bicarbonate
Sodium bicarbonate is a potent base. Adding a base to the blood counters high acid levels. The intravenous infusion of sodium bicarbonate is considered an active treatment plan for hyperchloremic acidosis and renal tubular acidosis, wherein the body loses its bicarbonate base due to diarrhoea, vomiting and kidney conditions.
4. Hemodialysis
Kidney dialysis is a potent treatment for serious kidney disease and kidney failure. A high level of urea in the blood is an indication of high acid content. Dialysis acts as artificial kidneys that help remove accumulated acids and other wastes from the blood. Doctors may also consider peritoneal dialysis in which a solution is used inside the body to absorb wastes.
5. Inotropes
Use of inotropes, drugs that regulate heart muscles to beat or contract with more or less power, respectively, and other heart medications that can control blood pressure and heart functioning can help treat metabolic acidosis. These drugs improve the flow of oxygen in the body and lower blood acid levels.
6. Detoxification
Metabolic acidosis caused due to alcohol abuse or drug poisoning is treated through detoxification. Hemodialysis may be used as a support technique.
How to Prevent Metabolic Acidosis?
Although metabolic acidosis may not always be prevented, certain precautions and lifestyle changes can lessen its incidence. These include:
1. Adequate Water Intake
Drinking adequate water allows the kidneys to filter out toxic acids in urine. This helps avoid acid buildup in the blood.
2. Quit Alcohol
Digestion of alcohol leads to the production of ketones. It also dehydrates the body, making the blood more acidic.
3. Quit Smoking
Smoking impairs the functioning of the lungs which can impair the respiratory compensation mechanism. As the lungs fail to remove all the carbon dioxide that the body produces, it makes the body fluids acidic. Quitting smoking improves lung condition.
4. Proper Diabetes Management
Proper diabetes management is important to avoid metabolic acidosis. The use of insulin, prescribed diabetes medication, and adequate fluids to restore electrolyte balance can aid in disease management.
5. Follow Medication Advice
Certain drugs can interact with each other, resulting in acid buildup. Following medication advice clearly can help avoid such episodes.
6. Dietary Changes
While fruits and vegetables are more alkaline, foods such as meats, eggs, cheese, and cereal grains are acidic. Therefore, increasing the intake of fruits and vegetables in the daily diet can reduce the acidity load in the blood.
Metabolic Acidosis Complications
The presence of acid in the blood can be chronic or episodic . This can lead to chronic or acute metabolic acidosis. pH balance of lower than 7.20 can have severe consequences. If left untreated, it can cause impaired circulation, organ failure and even death.
Chronic metabolic acidosis can vary between mild to moderate severity. It can lead to chronic kidney disease, loss of bone density, muscle wasting and delayed growth.
Conclusion
Metabolic acidosis is a condition marked by increased acid levels in the blood. The causes of acidosis are linked to three situations; the body fails to get rid of acid, produces too much acid, or does not have enough bases to neutralise the acids, leading to metabolic acidosis symptoms like fast breathing, weakness and fatigue. Depending upon the cause and symptoms, a metabolic acidosis treatment plan follows. While some people fully recover from the same, severe metabolic acidosis can lead to kidney failure, and shock and can even prove fatal. Thus, appropriate and quick treatment holds the key to quick and effective recovery.
