When the metabolism of the organism is out of balance, in untreated cases this can lead to coma and general intoxication, which can even have a fatal outcome. Metabolic acidosis is therefore a complication that should be subjected to prompt treatment.
What is metabolic acidosis?
Acidosis is a commonly known condition in which the pH shifts such that there is an increase in acidic components. For this reason, hyperacidity is achieved within the metabolism, which leads to damage to individual organs. If the pH value in the blood is measured during metabolic acidosis, results below 7.36 are not uncommon due to an increase in the concentration of hydrogen ions. This parameter is extremely alarming and indicates an increase in the acidity of the metabolism. This has to do with a derailment of the so-called acid-base balance.
Causes
Several criteria can be considered as causative triggers for metabolic acidosis. The balance between acids and bases in an endogenous metabolism can shift when people with diabetes mellitus have too high a sugar concentration in the context of hyperglycemia or fewer hydrogen ions can be excreted due to a loss of kidney function. Other causes of metabolic acidosis include urea intoxication, prolonged starvation, and permanent high-grade diarrhea. Conditions such as Addison’s disease, extensive burns, poisoning with methanol (alcohol), or fistulas located in the stomach can also cause metabolic acidosis. In all causes of metabolic acidosis, either increased accumulation of hydrogen ions, additional excretion of bicarbonates, or “accumulation” of hydrogen ions are present.
Typical symptoms and signs
- Shortness of breath
- Hyperventilation
- Frequent urination
- Bad breath
- Headache
- Low resilience
- Cardiac arrhythmias
- Low blood pressure (hypotension)
Diagnosis and course
Metabolic acidosis triggers an increased respiratory rate (hyperventilation) to rebalance the metabolism by increased exhalation of hydrocarbon ions. This particular respiration is known in medicine as Kußmaul’s respiration. It usually occurs in metabolic derailment due to diabetes mellitus. Another accompanying symptom of metabolic acidosis is the fruity smell of the mouth and urine of those affected. Clinically, metabolic acidosis also comes to the fore with reduced blood pressure. Disturbances in heart rhythm are also noteworthy in metabolic acidosis. Profound unconsciousness may also occur. The diagnosis of metabolic acidosis refers to the values of laboratory measurements in addition to clinical abnormalities and deficits in general condition. In metabolic acidosis, these include parameters such as creatinine and urea nitrogen in the serum, bicarbonate in the serum and urine, and primarily the pH of the urine. Further diagnosis is feasible in metabolic acidosis by carbon dioxide partial pressure.
Complications
In the worst case, this disease leads to the death of the patient. It is therefore imperative that it be treated by a physician to prevent secondary damage or other complications. As a rule, those affected suffer from severe shortness of breath and further also from hyperventilation. The shortness of breath can also cause a loss of consciousness, which can lead to a fall and thus possibly to injuries. The internal organs may also be undersupplied and damaged due to the shortness of breath. Furthermore, there is a very bad mouth odor, which can be very unpleasant for the affected person and outsiders. This can lead to social tensions. Furthermore, the patient’s ability to cope with stress also decreases significantly as a result of the disease, and severe headaches occur. The heart is also affected by the disease, resulting in disturbances of the heart rhythm and low blood pressure in the patient. The patient’s quality of life is significantly reduced. Treatment usually takes place with the help of medication. Furthermore, dialysis may also be necessary in the patient to prevent death.It is possible that this disease will reduce the life expectancy of the affected person.
When should you go to the doctor?
A visit to the doctor is advisable as soon as there is a feeling of illness or decreased performance. A doctor is needed in case of bad breath, headaches or decreasing physical as well as mental resilience. Fatigue, tiredness as well as a fast fatigue are signs of a present discrepancy. If the daily obligations can no longer be fulfilled, the affected person needs medical help. Disturbances of the heart rhythm, a strong palpitation or an increased pulse rate should be examined and treated. A low blood pressure that suddenly appears is a warning signal of the organism. A visit to the doctor is necessary so that a diagnosis can be made and treatment initiated. If breathing disorders occur, a doctor should also be consulted. Hyperventilation, a lack of oxygen or anxiety due to a shortage of breath should be presented to a doctor. In case of blue coloration of the skin or cold fingers and feet, there is an undersupply of oxygen to the organism. A medical check-up is therefore necessary as soon as there is a strong sensation of cold or blue lips. In the event of acute respiratory distress, an ambulance should be alerted. Until their arrival, first aid measures must be taken to ensure an adequate oxygen supply. Since metabolic acidosis in severe cases can lead to the premature death of the affected person, a visit to the doctor should be made at the first irregularities.
Treatment and therapy
Metabolic acidosis is compensated by emergency measures and further treatment. The acute signs of illness that occur with metabolic acidosis are relieved by additional ventilation and administration of bicarbonate. This results in an increased output of carbon dioxide through the lungs. If metabolic acidosis occurs in patients with diabetes, insulin levels must be increased rapidly to counteract diabetic acidosis. Bicarbonates for oral administration as tablets force the acid-base balance. If there is a suspicion that failure of kidney function is the original cause of metabolic acidosis, sufferers can undergo blood purification and detoxification by dialysis (blood washing). Abundant intake of appropriate fluids also reduces metabolic acidosis in the absence of unconsciousness.
Outlook and prognosis
Without medical care, the prognosis of metabolic acidosis is extremely unfavorable. Numerous complications, a comatose state, and premature death of the affected individual may occur. Therefore, it is strongly recommended to consult a physician at the first signs of health impairment. This is the only way to ensure the survival of the patient. Intensive medical care is required to achieve an improvement in health. The prospect of relief therefore increases if adequate medical care is initiated at an early stage. Otherwise, a continuous increase in very unpleasant health complaints is to be expected. Over a longer period of time, there will be a deterioration in the quality of life, a decrease in the ability to cope with stress, and disturbances in the heart rhythm. If other diseases of the cardiac rhythm system or organic disorders are present, the prognosis is additionally worsened. These patients in particular often suffer long-term health impairments despite all efforts and early medical care. In these cases, secondary disorders may occur, which must be taken into account when making the overall prognosis. The patient is dependent on drug therapy in the long term. In addition, they must undergo regular check-ups. Otherwise, the symptoms may relapse at any time and the disease may recur.
Prevention
In order to avoid metabolic acidosis by appropriate prophylaxis, the risk groups with a corresponding previous disease should consume an adequate amount of fluid daily and engage in physical activity. The amount of fluid should be at least 2500 ml per day.Metabolic acidosis can also be prevented in diabetes mellitus through proper insulin settings. People with bronchial asthma and with chronic kidney disease should implement their dietary and lifestyle habits based on medical advice. Excessive intake of alcoholic beverages and smoking are not recommended as preventive measures against metabolic acidosis in this context.
Follow-up
Because a metabolic disorder can have very diverse underlying causes, follow-up care must also be very individualized to the patient. Thus, there is no simple direction in the aftercare of metabolic acidosis. It is often not a disease in its own right, but a symptom or consequence of another systemic disease. Depending on the severity of the metabolic disorder, the specialist must adapt the aftercare to the patient. In some cases, it is not possible to cure the causative disease, which means that follow-up care must also be permanent, with regular check-ups and doctor’s appointments. As a rule, the symptoms can be largely suppressed; this can be achieved by the long-term administration of appropriate medication. In general, aftercare can aim to alleviate the accompanying symptoms. Affected persons should therefore ensure adequate fluid intake to avoid renewed hyperacidity.
What you can do yourself
A severe derailment of the so-called acid-base balance is a very serious disorder and potentially life-threatening. Risk groups should therefore be aware of the typical symptoms and consult a doctor promptly. Risk groups include in particular people suffering from diabetes mellitus, patients with severe diarrhea, as well as people who are chronically malnourished and alcoholics. In addition to a number of non-specific symptoms, metabolic acidosis results in an idiosyncratic mouth odor, often described as tart and fruity. The urine also often takes on a corresponding odor note. As soon as these symptoms appear, a doctor must be consulted immediately. Patients can also help themselves in this situation by increasing their fluid intake. In the case of acute hyperacidity, the affected person should promptly drink at least one liter of fluid. Alkaline medicinal waters are particularly recommended, otherwise normal mineral water or unsweetened tea can also be drunk. In the case of incorrectly adjusted diabetics, the insulin level often has to be increased rapidly. In addition, the administration of bicarbonates helps to restore the acid-base balance. Bicarbonates can be found in the form of soda, Kaiser soda, bullrich salt or baking powder in almost all households. In addition, the adequate intake of fluids, preferably at least 2.5 liters per day, in conjunction with sufficient exercise, can already prevent acidosis in patients at risk.
