eMedicine Specialties > Nephrology > Acid-Base, Fluid, and Electrolyte Disorders

Metabolic Acidosis: Follow-up

Author: Christie P Thomas, MBBS, FRCP, FASN, FAHA, Professor, Department of Internal Medicine, Division of Nephrology; Medical Director, Kidney and Kidney/Pancreas Transplant Program, University of Iowa Hospitals and Clinics
Coauthor(s): Khaled Hamawi, MD, Transplant Nephrology Consultant, King Faisal Specialist Hospital & Research Center
Contributor Information and Disclosures

Updated: Sep 16, 2009

Follow-up

Complications

  • In general, acute metabolic acidosis is well tolerated when blood pH exceeds 7.20. When blood pH is less than 7.20, cardiovascular complications can occur, including vasodilatation, myocardial depression, and decreased cardiac output, which manifest as hypotension.
  • Chronic metabolic acidosis can have long-term complications if left untreated. The main complication is bone disease (osteomalacia and osteopenia) caused by continual buffering of hydrogen ions.
  • Chronic metabolic acidosis increases the rate of skeletal muscle breakdown; this high catabolic state may contribute to loss of body mass and muscle weakness.

Miscellaneous

Medicolegal Pitfalls

  • In high-AG acidosis secondary to accumulation of organic acids, lactate, and ketones, these anions are eventually metabolized to HCO3 -. When the underlying disorder is treated, the serum pH corrects; thus, caution should be exercised in these patients when providing alkali to raise the pH much higher than 7.20 because an overshoot alkalosis may occur.
  • Potassium citrate is useful when the acidosis is accompanied by hypokalemia but should be used cautiously in the presence of renal impairment and must be avoided in the presence of hyperkalemia.
 


More on Metabolic Acidosis

Overview: Metabolic Acidosis
Differential Diagnoses & Workup: Metabolic Acidosis
Treatment & Medication: Metabolic Acidosis
Follow-up: Metabolic Acidosis
References
Further Reading
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References

  1. Noritomi DT, Soriano FG, Kellum JA, et al. Metabolic acidosis in patients with severe sepsis and septic shock: a longitudinal quantitative study. Crit Care Med. Aug 24 2009;[Medline].

  2. Pereira PC, Miranda DM, Oliveira EA, et al. Molecular pathophysiology of renal tubular acidosis. Curr Genomics. Mar 2009;10(1):51-9. [Medline]. [Full Text].

  3. Maciel AT, Park M. Differences in acid-base behavior between intensive care unit survivors and nonsurvivors using both a physicochemical and a standard base excess approach: A prospective, observational study. J Crit Care. Mar 26 2009;[Medline].

  4. Morimatsu H, Toda Y, Egi M, et al. Acid-base variables in patients with acute kidney injury requiring peritoneal dialysis in the pediatric cardiac care unit. J Anesth. 2009;23(3):334-40. [Medline].

  5. Walsh SB, Shirley DG, Wrong OM, et al. Urinary acidification assessed by simultaneous furosemide and fludrocortisone treatment: an alternative to ammonium chloride. Kidney Int. Jun 2007;71(12):1310-6. [Medline].

  6. Adrogue HJ. Metabolic acidosis: pathophysiology, diagnosis and management. J Nephrol. Mar-Apr 2006;19 Suppl 9:S62-9.

  7. Adrogue HJ, Madias NE. Disorders of acid-base balance. In: Schrier R, ed. Atlas of Diseases of the Kidney. ISN Informatics Commission and NKF cyberNephrology.; Available at: http://www.kidneyatlas.org/book1/adk1_06.pdf. [Full Text].

  8. Batlle D, Flores G. Underlying defects in distal renal tubular acidosis: new understandings. Am J Kidney Dis. Jun 1996;27(6):896-915. [Medline].

  9. Batlle DC, Hizon M, Cohen E, et al. The use of the urinary anion gap in the diagnosis of hyperchloremic metabolic acidosis. N Engl J Med. Mar 10 1988;318(10):594-9. [Medline].

  10. Bjerneroth G. Alkaline buffers for correction of metabolic acidosis during cardiopulmonary resuscitation with focus on Tribonat--a review. Resuscitation. Jun 1998;37(3):161-71. [Medline].

  11. Boron WF. Acid-base transport by the renal proximal tubule. J Am Soc Nephrol. Sep 2006;17(9):2368-82. [Medline].

  12. Burton, BD. Metabolic acidosis. In: Burton, BD and Post, T. Clinical Physiology of Acid-Base and Electrolyte Disorders. 5. New York, NY: McGraw-Hill; 1994:; 2001:578-646.

  13. DuBose TD Jr. Hyperkalemic hyperchloremic metabolic acidosis: pathophysiologic insights. Kidney Int. Feb 1997;51(2):591-602. [Medline].

  14. DuBose, TD. Acid Base Disorders. In: Brenner, BM. The Kidney. 1. 7. Philadelphia: Elsevier; 2004:948-971.

  15. Ellison, DH and Thomas, CP. Hereditary Disorders of Distal Nephron Sodium and Potassium Transport. In: Mount, DB and Pollark, MR. Molecular and Genetic Basis of Renal Disease: A companion to Brenner and Rector's The Kidney. 1. Philadelphia: Elsevier Health Sciences; 2007:16: 251-268.

  16. Ethier JH, Kamel KS, Magner PO, et al. The transtubular potassium concentration in patients with hypokalemia and hyperkalemia. Am J Kidney Dis. Apr 1990;15(4):309-15. [Medline].

  17. Forsythe SM, Schmidt GA. Sodium bicarbonate for the treatment of lactic acidosis. Chest. Jan 2000;117(1):260-7. [Medline].

  18. Halperin ML, Kamel KS. D-lactic acidosis: turning sugar into acids in the gastrointestinal tract. Kidney Int. Jan 1996;49(1):1-8. [Medline].

  19. Hamm LL, Simon EE. Roles and mechanisms of urinary buffer excretion. Am J Physiol. Oct 1987;253(4 Pt 2):F595-605. [Medline].

  20. Kahle KT, Wilson FH, Lalioti M, et al. WNK kinases: molecular regulators of integrated epithelial ion transport. Curr Opin Nephrol Hypertens. Sep 2004;13(5):557-62. [Medline].

  21. Kallet RH, Jasmer RM, Luce JM, et al. The treatment of acidosis in acute lung injury with tris-hydroxymethyl aminomethane (THAM). Am J Respir Crit Care Med. Apr 2000;161(4 Pt 1):1149-53. [Medline].

  22. Kamel KS, Halperin ML. An improved approach to the patient with metabolic acidosis: a need for four amendments. J Nephrol. Mar-Apr 2006;19 Suppl 9:S76-85.

  23. Karet FE. Inherited renal tubular acidosis. Adv Nephrol Necker Hosp. 2000;30:147-62. [Medline].

  24. Kurtzman NA. Renal tubular acidosis syndromes. South Med J. Nov 2000;93(11):1042-52. [Medline].

  25. Laing CM, Unwin RJ. Renal tubular acidosis. J Nephrol. Mar-Apr 2006;19 Suppl 9:S46-52.

  26. Magner PO, Robinson L, Halperin RM, et al. The plasma potassium concentration in metabolic acidosis: a re-evaluation. Am J Kidney Dis. Mar 1988;11(3):220-4. [Medline].

  27. McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University (Baltimore, MD) and National Center for Biotechnology Information, National Library of Medicine (Bethesda, MD). Online Mendelian Inheritance in Man. OMIM. Available at http://www.ncbi.nlm.nih.gov/Omim/. Accessed Mar 29, 2008.

  28. Strife CF, Clardy CW, Varade WS, et al. Urine-to-blood carbon dioxide tension gradient and maximal depression of urinary pH to distinguish rate-dependent from classic distal renal tubular acidosis in children. J Pediatr. Jan 1993;122(1):60-5. [Medline].

  29. Wrenn KD, Slovis CM, Minion GE, et al. The syndrome of alcoholic ketoacidosis. Am J Med. Aug 1991;91(2):119-28. [Medline].

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Further Reading

Related eMedicine topics:
 Acidosis, Metabolic
Alkalosis, Metabolic
Alkalosis, Respiratory
Hypercalcemia [Emergency Medicine]
Hypercalcemia [Nephrology]
Hypercalcemia [Pediatrics: General Medicine]
Hyperkalemia [Emergency Medicine]
Hyperkalemia [Nephrology]
Hyperkalemia [Pediatrics: Cardiac Disease and Critical Care Medicine]
Hypermagnesemia [Emergency Medicine]
Hypermagnesemia [Nephrology]
Hypermagnesemia [Pediatrics: General Medicine]
Hyperphosphatemia [Emergency Medicine]
Hyperphosphatemia [Nephrology]
Hypocalcemia [Emergency Medicine]
Hypocalcemia [Nephrology]
Hypocalcemia [Pediatrics: General Medicine]
Hypochloremic Alkalosis
Hypokalemia [Emergency Medicine]
Hypokalemia [Nephrology]
Hypokalemia [Pediatrics: Cardiac Disease and Critical Care Medicine]
Hypomagnesemia [Emergency Medicine]
Hypomagnesemia [Nephrology]
Hypomagnesemia [Pediatrics: General Medicine]
Hypophosphatemia [Emergency Medicine]
Hypophosphatemia [Nephrology]
Metabolic Alkalosis
Respiratory Acidosis
Respiratory Alkalosis

Clinical guidelines:
Cerebral Edema in Pediatric Diabetic Ketoacidosis

Human Milk Fortifiers and Acid-Base Status

Study of Idebenone in the Treatment of Mitochondrial Encephalopathy Lactic Acidosis & Stroke-like Episodes (MELAS)

Study On the Role of Mitochondrial Dysfunction in the Pathogenesis of Metformin-associated Lactic Acidosis

Uremic Toxins in the Intensive Care Units (ICU): Patients With Lactate Acidosis

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Keywords

metabolic acidosis, acidosis, anion gap, renal tubular acidosis, acidosis renal tubular, renal acidosis, respiratory acidosis, gap acidosis, anion acidosis, acid-base balance, acid-base disorder, acidosis, acidemia, metabolic alkalosis, alkalosis, alkalemia, blood pH, bicarbonate, anion gap acidosis, normal anion gap metabolic acidosis, plasma bicarbonate, plasma bicarbonate level

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Contributor Information and Disclosures

Author

Christie P Thomas, MBBS, FRCP, FASN, FAHA, Professor, Department of Internal Medicine, Division of Nephrology; Medical Director, Kidney and Kidney/Pancreas Transplant Program, University of Iowa Hospitals and Clinics
Christie P Thomas, MBBS, FRCP, FASN, FAHA is a member of the following medical societies: American College of Physicians, American Federation for Medical Research, American Heart Association, American Society of Nephrology, American Society of Transplantation, American Thoracic Society, International Society of Nephrology, and Royal College of Physicians
Disclosure: Genzyme Grant/research funds Other

Coauthor(s)

Khaled Hamawi, MD, Transplant Nephrology Consultant, King Faisal Specialist Hospital & Research Center
Khaled Hamawi, MD is a member of the following medical societies: American Society of Nephrology and American Society of Transplantation
Disclosure: Nothing to disclose.

Medical Editor

James W Lohr, MD, Fellowship Program Director, Professor, Department of Internal Medicine, Division of Nephrology, State University of New York at Buffalo
James W Lohr, MD is a member of the following medical societies: American College of Physicians, American Heart Association, American Society of Nephrology, and Central Society for Clinical Research
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Eleanor Lederer, MD, Consulting Staff, Louisville VA Hospital; Professor of Medicine; Interim Chief of Nephrology; Director of Nephrology Training Program; Director, Metabolic Stone Clinic; Director of Outpatient Clinics, Kidney Disease Program, University of Louisville School of Medicine
Eleanor Lederer, MD is a member of the following medical societies: American Association for the Advancement of Science, American Federation for Medical Research, American Society for Biochemistry and Molecular Biology, American Society for Bone and Mineral Research, American Society of Nephrology, American Society of Transplantation, International Society of Nephrology, Kentucky Medical Association, National Kidney Foundation, and Phi Beta Kappa
Disclosure: Nothing to disclose.

CME Editor

Rebecca J Schmidt, DO, FACP, FASN, Professor of Medicine, Section Chief, Department of Medicine, Section of Nephrology, West Virginia University School of Medicine
Rebecca J Schmidt, DO, FACP, FASN is a member of the following medical societies: American College of Osteopathic Internists, American College of Physicians, American Medical Association, American Society of Nephrology, International Society of Nephrology, National Kidney Foundation, Renal Physicians Association, and West Virginia State Medical Association
Disclosure: Abbott Grant/research funds Speaking and teaching; Genzyme Honoraria Consulting; Amgen Honoraria Speaking and teaching; Ortho Biotech Honoraria Speaking and teaching

Chief Editor

Vecihi Batuman, MD, FACP, FASN, Professor of Medicine, Section of Nephrology-Hypertension, Tulane University School of Medicine; Chief, Medicine Service, Southeast Louisiana Veterans Health Care System
Vecihi Batuman, MD, FACP, FASN is a member of the following medical societies: American College of Physicians, American Society of Hypertension, American Society of Nephrology, and International Society of Nephrology
Disclosure: Nothing to disclose.

 
 
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