Metabolic Acidosis: Causes, Symptoms, and Treatment Explained

What is Metabolic Acidosis?

Metabolic acidosis is a serious condition characterised by an imbalance in the body's acid-base balance, leading to an excessive accumulation of acid in the blood and other body fluids. It occurs when either too much acid is produced or the kidneys are unable to remove enough acid from the body. As a result, the blood pH falls below the normal range of 7.35 to 7.45, a state known as acidemia.

Metabolic acidosis can have significant effects on various organ systems if left untreated. It's important to understand the causes of metabolic acidosis, recognise the signs and symptoms, and seek prompt medical care. With proper diagnosis and treatment, it's possible to manage metabolic acidosis effectively and prevent serious complications.

The Role of Kidneys in Acid-Base Balance

The kidneys play a vital role in maintaining the body's acid-base balance, ensuring that the blood pH remains within the normal range of 7.35–7.45. This balance is crucial for proper cellular function and overall health. The kidneys achieve this through multiple mechanisms that regulate the levels of acids and bases in the blood.

• Excretion of Hydrogen Ions: The kidneys help remove excess hydrogen ions, which contribute to acidity in the body. These ions are excreted in urine, preventing a dangerous drop in blood pH.
• Reabsorption of Bicarbonate: Bicarbonate is an essential base that neutralises excess acids in the blood. The kidneys filter bicarbonate and reabsorb it into the bloodstream, ensuring a stable pH balance.
• Production of Ammonia: The kidneys generate ammonia, which binds to hydrogen ions to form ammonium. This process helps eliminate acid efficiently while conserving bicarbonate.

When kidney function is impaired, such as in chronic kidney disease (CKD) or kidney failure, the body's ability to regulate acid levels is compromised. This can lead to metabolic acidosis, a condition where excess acid accumulates in the body due to inadequate excretion. The consequences of metabolic acidosis are:

• Fatigue and muscle weakness
• Bone demineralisation, increasing the risk of fractures
• Increased inflammation and cardiovascular complications
• Impaired enzyme function, affecting metabolism

Common Causes of Metabolic Acidosis

Several metabolic acidosis diseases and conditions can lead to an excess of acid in the body. Some common reasons for metabolic acidosis include:

• Chronic kidney disease (CKD) or kidney failure
• Uncontrolled diabetes leading to diabetic ketoacidosis
• Severe diarrhoea causing loss of bicarbonate
• Lactic acidosis due to oxygen deprivation in tissues
• Ingestion of certain drugs or toxins

In CKD, the gradual loss of kidney function impairs acid excretion, leading to acid accumulation. Diabetic ketoacidosis occurs when the body produces high levels of ketones due to insufficient insulin. Severe diarrhoea can cause excessive loss of bicarbonate, reducing the body's ability to neutralize acids.

It's crucial to identify the underlying cause of metabolic acidosis to guide appropriate treatment. Healthcare providers will consider your medical history, symptoms, and test results to determine the specific reason for metabolic acidosis in your case.

Symptoms of Metabolic Acidosis

Metabolic acidosis occurs when the body accumulates too much acid or loses too much bicarbonate, disrupting the acid-base balance. Metabolic acidosis symptoms can range from mild to severe, depending on the underlying cause and the body's ability to compensate for the imbalance.

Common Symptoms

• Rapid and deep breathing (Kussmaul breathing): The body tries to expel excess carbon dioxide to reduce acidity.
• Confusion and disorientation: Acid buildup affects brain function, leading to cognitive impairment.
• Fatigue and weakness: Muscle function declines due to imbalanced pH levels.
• Headache: Increased acidity can cause blood vessel changes in the brain.
• Nausea and vomiting: The body attempts to expel excess acid through the digestive system.
• Increased heart rate (tachycardia): The heart works harder to compensate for acid-base imbalances.

Severe Symptoms

• Shock: A life-threatening condition due to poor circulation and oxygen delivery.
• Coma: Extreme acid buildup can impair brain function, leading to unconsciousness.
• Death: If untreated, severe metabolic acidosis can be fatal.

Diagnosing Metabolic Acidosis

If your healthcare provider suspects metabolic acidosis, they will likely order several tests to confirm the diagnosis and determine the underlying cause. The diagnostic process typically involves:

• Blood tests: Measuring serum pH and bicarbonate levels can help diagnose metabolic acidosis. A decreased bicarbonate concentration (less than 22 mEq/L) and a pH below 7.35 are indicative of the condition.
• Urine tests: Analysing urine samples can provide insights into the body's acid excretion and kidney function. The presence of certain compounds in urine can help identify the specific type of metabolic acidosis.
• Other tests: Depending on the suspected cause, additional tests such as blood glucose, lactate levels, or imaging scans may be ordered to evaluate organ function and guide treatment.

Your healthcare provider will interpret the test results in the context of your medical history and symptoms to make an accurate diagnosis. They may also classify metabolic acidosis into subtypes based on the underlying mechanism, such as hyperchloremic acidosis or lactic acidosis, to tailor the treatment approach.

Treatment Options for Metabolic Acidosis

Metabolic acidosis treatment focuses on addressing the underlying cause while correcting the acid-base imbalance. Some common treatment strategies include:

• Treating the underlying condition: Managing conditions like CKD, diabetes, or infections can help prevent further acid accumulation and promote recovery.
• Alkali therapy: Administering bicarbonate or other alkalizing agents can help neutralize excess acids and restore the normal pH balance. This may be done through oral medications or intravenous infusions.
• Dietary modifications: In some cases, dietary changes such as reducing protein intake or increasing fruits and vegetable consumption may be recommended to minimise acid load.
• Dialysis: In severe cases of metabolic acidosis related to kidney failure, dialysis may be necessary to remove excess acids and correct electrolyte imbalances.

Regular monitoring of blood pH and electrolyte levels is crucial to assess treatment response and make necessary adjustments for metabolic acidosis diseases.

Preventing Metabolic Acidosis: Tips for Kidney Health

Preventing metabolic acidosis requires maintaining kidney health and minimising factors that contribute to acid buildup in the body. Since the kidneys play a crucial role in regulating acid-base balance, adopting healthy lifestyle habits can support their function and reduce the risk of acidosis.

One of the most important steps is staying well-hydrated. Drinking plenty of water throughout the day helps the kidneys flush out excess acids and toxins, promoting a balanced pH level. Proper hydration also supports overall kidney function and prevents complications like kidney stones.

A balanced diet is essential for acid-base regulation. Consuming fruits and vegetables, which have an alkalizing effect, can help neutralize excess acid. At the same time, limiting acid-forming foods like animal proteins can reduce the strain on the kidneys.

Managing underlying health conditions such as diabetes or chronic kidney disease is also vital. Working closely with a healthcare provider ensures these conditions remain controlled, preventing metabolic acidosis diseases. Additionally, limiting alcohol intake helps prevent dehydration and excessive acid production, further supporting kidney health.

The Link Between Metabolic Acidosis and Chronic Kidney Disease

Chronic kidney disease (CKD) is one of the most common conditions associated with metabolic acidosis. The kidneys play a crucial role in maintaining acid-base balance by filtering and excreting excess acids. However, as kidney function declines, they become less efficient at removing acids, leading to their accumulation in the blood. This results in metabolic acidosis, which can negatively impact overall health.

Untreated metabolic acidosis can further accelerate kidney damage, creating a harmful cycle. Excess acid in the blood contributes to inflammation, bone loss, and muscle breakdown, all of which can worsen CKD progression. Additionally, metabolic acidosis affects hormone regulation and increases the risk of complications such as cardiovascular disease.

Early diagnosis and management of metabolic acidosis are essential for preserving kidney function in people with CKD. Dietary changes, medications like bicarbonate supplements, and proper hydration can help maintain acid-base balance and slow disease progression.

Dietary Recommendations for Managing Metabolic Acidosis

Making dietary changes is a crucial part of managing metabolic acidosis. To maintain a healthy acid-base balance, it is essential to choose foods that reduce acid buildup and support kidney function.

One of the key recommendations is to reduce the intake of animal proteins, as they are acid-forming and can contribute to the progression of metabolic acidosis. Instead, opting for plant-based protein sources such as lentils, beans, and tofu can help minimise acid load while providing essential nutrients.

Increasing the consumption of fruits and vegetables, particularly those high in potassium like bananas, spinach, and avocados, is beneficial. These foods have an alkalising effect and help counteract acid buildup in the body.

Additionally, limiting processed foods is important, as they often contain acid-forming additives. Avoiding excessive caffeine intake is also recommended, as it can contribute to dehydration and worsen acid accumulation. These dietary adjustments can support kidney health and help manage metabolic acidosis effectively.

When to See a Doctor for Metabolic Acidosis
 

It is important to seek medical attention if you experience symptoms of metabolic acidosis, such as rapid breathing, confusion, fatigue, nausea, or an irregular heartbeat. These symptoms indicate an imbalance in the body's acid-base levels, which can be dangerous if left untreated.

Individuals with chronic kidney disease, diabetes, or other conditions that increase the risk of metabolic acidosis should be especially vigilant. If symptoms worsen or persist, immediate medical evaluation is necessary. Severe cases can lead to shock or coma, making early diagnosis and treatment essential to prevent complications and protect overall health.

Conclusion

Doctors define metabolic acidosis as a condition where excess acid builds up in the body, potentially harming kidney function. Recognising symptoms, understanding causes, and making lifestyle changes can help manage it. Consult a doctor promptly for early diagnosis and effective treatment.

At Metropolis Healthcare, we understand the importance of accurate diagnostics in managing conditions like metabolic acidosis. Our network of advanced diagnostic labs across India and team of skilled phlebotomists are committed to providing reliable pathology testing and convenient at-home sample collection services. We believe in empowering our patients with the knowledge and tools they need to prioritise their health.