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In this article, we'll teach you all about metabolic acidosis, including: the difference between uncompensated, partially-compensated, and fully compensated, and the lab values you can expect to see with each of those; what causes metabolic acidosis; and its symptoms and treatment.
The following steps use lab values and equations to determine if a patient has metabolic acidosis and any additional acid-base disturbances. Step 1: pH, determine if the acid-base status is acidemia or alkalemia
Metabolic acidosis is a condition in which acids build up in your body. Causes include untreated diabetes, the loss of bicarbonate in your body and kidney conditions. Symptoms include an accelerated heartbeat, confusion and fatigue. Blood and urine tests can help diagnose it.
Several laboratory measurements are useful in metabolic acidosis, such as arterial blood gas sampling, electrolytes, serum lactate and ketone concentrations, as well as toxicological screening (salicylate level, methanol, or ethylene glycol).
Bicarbonate <22 mM with a normal anion gap indicates a pure non-anion-gap metabolic acidosis (NAGMA). Bicarbonate >28 mM with a normal anion gap indicates a pure metabolic alkalosis. A bicarbonate of 22-28 mm with a normal anion gap indicates a normal metabolic pH status.
Use one of several formulas, rules-of-thumb, or an acid-base nomogram to determine if laboratory values are consistent with a single acid-base disorder (and compensation) or if a second primary acid-base disorder is also present.
Calculate AG to reveal an anion gap metabolic acidosis (can be hidden when pH is normal but mixed disorders are present). Compare AG and HCO3 to look for concurrent metabolic alkalosis or normal anion gap metabolic acidosis.
Metabolic acidosis can be caused by acid accumulation due to increased acid production or acid ingestion; decreased acid excretion; or gastrointestinal or renal bicarbonate (HCO 3 −) loss. Metabolic acidoses are categorized based on whether the anion gap is high or normal.
The only definitive way to diagnose metabolic acidosis is by simultaneous measurement of serum electrolytes and arterial blood gases (ABGs) that shows pH and partial pressure of arterial carbon...
Diagnosis. Treatment. Key Points. Metabolic acidosis is primary reduction in bicarbonate (HCO 3− ), typically with compensatory reduction in carbon dioxide partial pressure (P co2 ); pH may be markedly low or slightly subnormal.