Metabolic acidosis: what it is, symptoms and treatments

To properly perform its vital functions, the body must maintain a precise acid-base balance (or pH), which represents one of the great pillars of our well-being. This means that the blood must be neither too acidic nor too alkaline, but somewhere in between, of which 7.4 is the optimal value. «Below this threshold we speak of acidosisabove instead of alkalosis»Explains the professor Lelio Morricone, head of the Diabetology and Metabolic Diseases Service at the Sant’Ambrogio Clinical Institute in Milan. But what can lead to a reduction in pH? Sometimes there may be an abnormality in the respiratory function, whereby the lungs cannot excrete enough carbon dioxide produced by the body (respiratory acidosis), while other times there are metabolic diseases, severe infections, dehydration or intoxication (metabolic acidosis).


What is Metabolic Acidosis

All the activities that take place in the body to supply organs and muscles with energy, such as the metabolism of fats, carbohydrates and proteins, generate waste (many of which are acidic) which are eliminated through the intestines, kidneys, skin and lungs. If something goes wrong, the body is no longer able to remove these waste products, which begin to accumulate: “In most cases, this situation occurs in the case of renal insufficiency or decompensated diabetes”, explains Professor Morricone.


What are the causes of metabolic acidosis

The kidneys eliminate substances (both acidic and basic) that the body must excrete, including urea, creatinine, uric acid and phosphate. When kidney function fails, acids produced by metabolic processes accumulate in the blood and this is associated with muscle catabolism (breaking down of proteins from the muscles for energy), bone resorption and further progression of kidney disease.

“In the case of diabetes, on the other hand, especially in type 1 diabetes, a situation of ketoacidosis can arise. In other words, due to the lack of insulin, mechanisms are triggered at the cellular level that lead to the excessive formation of ketone bodies, compounds normally present in the blood in small quantities: these constitute a sort of emergency “fuel” for the cells and are produced in conditions of lack of glucose or in the case in which the lack of insulin makes it impossible for the cells to use glucose as an energy source ».

Most of these compounds (the best known is commonly called acetone) is strongly acidic, so an excess also “acidifies” the whole organism. “Today, however, this is a rare occurrence, because diabetes is more easily monitored and compensated for than in the past,” Professor Morricone points out.


What are the consequences

If not properly treated, a protracted condition of metabolic acidosis can poison the body and lead to various consequences, ranging from a generic risk for various co-morbidities to the danger of coma, if the phenomenon is acute or very intense.


Symptoms of metabolic acidosis and diagnosis

Metabolic acidosis can be suspected based on several symptoms. “Beyond one chronic fatigue that persists even after resting or which is in any case exaggerated compared to the effort made, nausea, vomiting, lack of appetite, irregular breathing, bad breath, muscle cramps often occur and, in the case of decompensated diabetes, the symptoms are accompanied by an increase in thirst and an increased frequency of urination ».

But one certain diagnosis it can only come with a named laboratory investigation blood gas analysis (EGA), an “instant” test that uses an arterial sample (usually at the level of the wrist, radial artery, or in the fold of the elbow, brachial artery) and non-venous like common blood tests: “From the result, doctors are able to accurately detect the blood pHthe possible degree of acidosis and the way in which the body is trying to correct this situation ”, explains the expert.


The other exams

In patients with diabetes, the dosage of ketone bodies in the urine may be useful, which can also be “tested” with common indicator papers sold in pharmacies: just put a paper under the jet of urine and check, after a few moments, the change of color.


How it comes

While in the case of diabetes the treatment consists of an adequate dose of insulin to block the release of ketone bodies, in renal insufficiency or in other situations of metabolic acidosis it is generally prescribed sodium bicarbonate in tablets, which is absorbed by the intestine and then introduced into the bloodstream where it neutralizes the accumulated acids. “Often we also read about alkalizing diets or, on the contrary, acidifying foods that can make the situation worse. In reality, nutrition alone cannot solve or cause damage, because our organism has a perfect regulation system. It is only as a consequence of important organic pathologies that acidosis can make its way, but today specialists are very skilled in identifying the problem early in order to avoid long-term damage ”, concludes Professor Morricone.