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What Is Involved in Metabolic Acidosis Management?

By Alexis Rohlin
Updated May 17, 2024
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Metabolic acidosis management is the process of treating metabolic acidosis, a serious, life-threatening medical condition. The condition occurs when there is a build-up of acid in the blood that the kidneys cannot remove. Management of metabolic acidosis can be broken down into four steps: emergency, cause, losses and specifics (ECLS).

Shortness of breath, rapid heartbeat, chest pain, nausea, vomiting and fainting are all metabolic acidosis symptoms. These symptoms can be quite severe and typically require immediate medical care. This is the "emergency" step of metabolic acidosis management. Paramedics treating the patient may administer oxygen, cardiopulmonary resuscitation (CPR) or an electric shock via an external defibrillator to make the patient's heart return to its normal rhythm.

After the initial life-threatening symptoms have been treated, metabolic acidosis management moves into its second stage — treating the underlying cause of the condition. Common causes of metabolic acidosis are diabetes, kidney failure or lactic acidosis. Blood tests are performed to determine the specific cause, so doctors will know how to treat the problem.

Fluids, electrolytes and insulin are administered to a patient whose metabolic acidosis is caused by diabetic ketoacidosis. When the level of insulin in a diabetic person's body becomes too low, his body cannot use sugar as an energy source and will begin to burn body fat. The process of breaking down body fat to convert to fuel causes the release of ketones. High levels of ketones are toxic to the body. Symptoms of diabetic ketoacidosis may be rapid breathing or shortness of breath, a flushed face, heart attack, vomiting, fatigue and, in severe cases, coma.

If the cause of metabolic acidosis is kidney failure, then the patient may be treated with hemodialysis, the process of using a machine to remove toxins from the blood. Kidney failure occurs when the kidneys cannot filter out waste products or toxins, such as potassium, from the blood. When metabolic acidosis causes potassium to build up to toxic levels in the blood, it causes an irregular heartbeat, chest pain, dizziness, nausea, rapid heartbeat and shortness of breath. Within an hour of potassium building up to dangerous levels in the blood, the heartbeat slows and a person’s pulse weakens or stops altogether, causing him to faint.

When oxygen blood levels drop, the body produces lactic acid. Lactic acidosis occurs when lactic acid builds up in the blood and the body is unable to remove it. Symptoms of lactic acidosis include rapid breathing or hyperventilation, vomiting, rapid heartbeat, low blood pressure and anemia. If the cause of metabolic acidosis is lactic acidosis, then metabolic acidosis management may involve giving the patient fluids and — if he has kidney failure or congestive heart failure — using dialysis to remove the excess lactic acid.

In the third step of metabolic acidosis management, fluids and electrolytes that have been lost are replaced. Fluid replacement may include an infusion of saline or a fluid solution of sodium bicarbonate. The fourth step of metabolic acidosis management is coming up with an ongoing drug treatment plan for the specific disease and medical conditions associated with metabolic acidosis, such as kidney failure and diabetes.

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