eMedicine Specialties > Emergency Medicine > Endocrine & Metabolic

Metabolic Acidosis: Follow-up

Author: Antonia Hipp, DO, Assistant Professor, Assistant Residency Director, Department of Emergency Medicine, State University of New York Downstate Medical Center/Kings County Hospital Center; Consulting Staff, Department of Emergency Medicine, Kings County Hospital Center
Coauthor(s): Richard Sinert, DO, Associate Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Department of Emergency Medicine, Kings County Hospital Center
Contributor Information and Disclosures

Updated: Sep 11, 2008

Follow-up

Prognosis

  • Because metabolic acidosis is a condition that occurs in response to a variety of disease states, the prognosis is directly related to the underlying etiology and the ability to treat or correct that particular disorder.

Miscellaneous

Medicolegal Pitfalls

  • Failure to recognize the underlying disorder that resulted in metabolic acidosis can lead to serious consequences for the patient.

Special Concerns

  • Acute renal failure (ARF), defined as a urine output of less than 400 mL in a 24-hour period, can lead to metabolic acidosis.
    • Volume and electrolyte balance are critical issues in such cases and frequent arterial blood gas analyses may be required. Hyperkalemia may develop rapidly and can be fatal. Potassium restriction is essential. Sodium bicarbonate may produce unexpected volume and salt retention. Peritoneal or hemodialysis may be required in such cases.
    • Indications for dialysis in acute renal failure include hyperkalemia, hypernatremia, volume overload, severe acidosis, and progressive uremia.
  • Caution should be exercised in the treatment of elderly patients with metabolic acidosis. In addition to identifying the underlying cause, it is imperative to recognize the relatively fragile nature of these patients and the potential for adverse effects related to treatment.
    • Metabolic acidosis can have deleterious effects on myocardial contractility and response to catecholamines, thereby leading to cardiac arrhythmias and worsening heart failure.
    • Hypervolemia and salt retention associated with the administration of sodium bicarbonate may lead to congestive heart failure. The ability of the respiratory system to compensate for metabolic acidosis may be impaired because of underlying pulmonary disease and ineffective gas exchange.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Karen L Stavile, MD, to the development and writing of this article.



More on Metabolic Acidosis

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

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Keywords

metabolic acidosis, increase in total body acid, acidemia, pH <7.10, renal tubular acidosis, RTA, tachypnea, hyperpnea, Kussmaul respiration, hyperventilation, chronic metabolic acidosis, uremia, renal failure, hypoaldosteronism, lactic acidosis, ketoacidosis

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Contributor Information and Disclosures

Author

Antonia Hipp, DO, Assistant Professor, Assistant Residency Director, Department of Emergency Medicine, State University of New York Downstate Medical Center/Kings County Hospital Center; Consulting Staff, Department of Emergency Medicine, Kings County Hospital Center
Antonia Hipp, DO is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Richard Sinert, DO, Associate Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Department of Emergency Medicine, Kings County Hospital Center
Richard Sinert, DO is a member of the following medical societies: American College of Physicians and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Erik D Schraga, MD, Consulting Staff, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates; Consulting Staff, Permanente Medical Group, Kaiser Permanente, Santa Clara Medical Center
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Howard A Bessen, MD, Professor of Medicine, Department of Emergency Medicine, UCLA School of Medicine; Program Director, Harbor-UCLA Medical Center
Howard A Bessen, MD is a member of the following medical societies: American College of Emergency Physicians
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
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