What Is Metabolic Acidosis?

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.

Hyperchloremic acidosis. Severe diarrhea, laxative abuse, and kidney problems can cause lower levels of bicarbonate, the base that helps neutralize acids in blood.

Respiratory acidosis also results in blood that's too acidic. But it starts in a different way, when your body has too much carbon dioxide because of a problem with your lungs.

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Symptoms

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.

Testing

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

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.

The earlier you're treated, the better. Common treatments include:

  • 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.

Prevention

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.

WebMD Medical Reference Reviewed by Michael Dansinger, MD on January 17, 2017

Sources

SOURCES:

American Academy of Family Physicians: "Diabetic Ketoacidosis."

National Kidney and Urologic Diseases Information Clearinghouse: "Renal Tubular Acidosis."

Gennari, F. Clinical Journal of the American Society of Nephrology, November 2008.

Medscape: "Metabolic Acidosis Clinical Presentation," "Metabolic Acidosis Workup," "Metabolic Acidosis: Pathophysiology, Diagnosis and Management: Adverse Effects of Metabolic Acidosis," "Metabolic Acidosis Medication."

American Diabetes Association: "DKA (Ketoacidosis) & Ketones."

Scott & White Healthcare: "Metabolic Acidosis."

UCSF School of Medicine: "Metabolic Acidosis -- Anion Gap."

Joslin Diabetes Center: "Ketone Testing: What You Need to Know."

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