The following symptoms and complaints may indicate metabolic (metabolic-related) acidosis: Hyperventilation–increased breathing. Acidosis breathing – deep breathing, so-called kissing mouth breathing. Bradycardia – too slow heartbeat: < 60 beats per minute. Hyperkalemia (excess potassium) Anorexia (loss of appetite) Adynamia – weakness, lack of strength Lack of concentration Fatigue Shock
Pathogenesis (disease development) Metabolic acidosis is defined as a metabolic decrease in blood pH <7.36. Possible causes of metabolic acidosis include: Addition Acidosis and Subtraction Acidosis Metabolic acidosis can result either from increased metabolic uptake or production of acids (addition acidosis) or from increased losses of bases (HCO3; hydrogen carbonates, obsoletely also bicarbonates) (subtraction acidosis). … Metabolic Acidosis: Causes
The primary focus of any therapy is to treat the underlying condition in question–for example, renal insufficiency (kidney weakness). General measures Alcohol restriction (abstaining from alcohol), as alcohol has an acid-forming effect. Limited caffeine consumption (max. 240 mg of caffeine per day; this corresponds to 2 to 3 cups of coffee or 4 to 6 … Metabolic Acidosis: Therapy
Acid-base status PH ↓ Bicarbonate (HCO3-) current ↓ Bicarbonate standard ↓ Blood carbon dioxide partial pressure (pCO2) – normal [decreased after partial compensation by hyperventilation [hypocapnia)]. Base excess (base excess) ↓ BasenexcessThe negative base deviation marks an increased need for bases. Other possible examinations Other possible examinations Blood oxygen partial pressure (pO2) – unchanged. Oxygen … Metabolic Acidosis: Test and Diagnosis
Therapeutic target Restoration of a physiological pH value Therapy recommendations Treatment of the underlying condition: Diabetic ketoacidosis: adequate volume replacement, sufficient insulin administration (i.v.) until ketone body production is stopped and, at the same time, substitution of the frequently accompanying potassium deficit Intoxications ((poisonings): Methanol or ethylene glycol/glycols (dialcohols (divalent alcohols) derived from ethylene glycol): … Metabolic Acidosis: Drug Therapy
Optional medical device diagnostics–depending on the results of history, physical examination, laboratory diagnostics, and obligatory medical device diagnostics–for differential diagnostic workup Abdominal ultrasonography (ultrasound examination of abdominal organs) – for diagnosis of renal disease or diarrhea (diarrhea). Electrocardiogram (ECG; recording of the electrical activity of the heart muscle) – to exclude cardiac arrhythmias in electrolyte … Metabolic Acidosis: Diagnostic Tests
Appropriate alkaline minerals for metabolic acidosis are: Na-bicarbonate Potassium citrate Magnesium citrate Calcium citrate Important notice. An alkaline food supplement, for example, with Na-bicarbonate as sodium hydrogen carbonate, is incompatible with the stomach if no gastric acid-resistant encapsulation is chosen. The supply of sodium hydrogen carbonate without gastric acid-proof encapsulation leads to CO2 formation in … Metabolic Acidosis: Micronutrient Therapy
To prevent metabolic (metabolic-related) acidosis, attention must be paid to reducing individual risk factors. Behavioral risk factors Diet Starvation state – increased acid production Overeating – increased acid production Environmental pollution – intoxications (poisonings). Ethylene glycol – used as an antifreeze. Methanol
Medical history (history of illness) represents an important component in the diagnosis of metabolic (metabolic-related) acidosis. Family history Is there a history of frequent kidney disease in your family? Social history Current medical history/systemic history (somatic and psychological complaints). Have you noticed that your breathing has changed? (increased and deep breathing) Do you suffer from … Metabolic Acidosis: Medical History
Endocrine, nutritional, and metabolic diseases (E00-E90). Starvation state Hyperkalemia (excess potassium) due to generalized dysfunction of distal nephrons. Lactic acidosis – acidosis due to excessive blood lactate levels (plasma lactate level ≥ 2.0 mmol/l and a pH of < 7.35) Hypokalemia (potassium deficiency) due to renal (kidney-related) acidosis. Ketoacidosis – caused by diabetes mellitus (diabetes) … Metabolic Acidosis: Or something else? Differential Diagnosis
The following are the major diseases or complications that may be contributed to by metabolic (metabolic-related) acidosis: Blood, hematopoietic organs – Immune system (D50-D90). Loss of activity of NK cells (natural killer cell; natural killer cells). Inhibition of lymphocyte proliferation (infection defense). Erythropoietin resistance (renal anemia). Endocrine, nutritional, and metabolic diseases (E00-E90). Increase in parathyroid … Metabolic Acidosis: Complications
A comprehensive clinical examination is the basis for selecting further diagnostic steps: General physical examination–including blood pressure, pulse, body weight, height; further: Inspection (viewing). Skin, mucous membranes and sclerae (white part of the eye). Auscultation (listening) of the heart [bradycardia (heartbeat too slow: < 60 beats per minute)] Auscultation of the lungs [hyperventilation – increased … Metabolic Acidosis: Examination