From the Guidelines
Vomiting is not typically associated with metabolic acidosis, but rather with metabolic alkalosis, except in specific situations where there is a loss of bicarbonate-rich secretions or retention of acidic gastric contents. These situations can include pyloric stenosis or duodenal obstruction, where the stomach contents are expelled during vomiting, but the acidic gastric secretions remain in the body, as described in general medical knowledge. Metabolic acidosis can also occur with prolonged vomiting due to starvation ketoacidosis, where the body breaks down fat for energy, producing ketone bodies that cause acidosis 1. Furthermore, severe volume depletion from vomiting can lead to lactic acidosis due to poor tissue perfusion. The treatment of metabolic acidosis associated with vomiting involves addressing the underlying cause, providing fluid resuscitation with appropriate electrolyte replacement, and in severe cases, administering sodium bicarbonate to correct the acid-base imbalance, as is standard practice in clinical medicine.
Causes of Metabolic Acidosis with Vomiting
- Loss of bicarbonate-rich pancreatic secretions from the lower gastrointestinal tract
- Retention of acidic gastric secretions, as seen in pyloric stenosis or duodenal obstruction
- Starvation ketoacidosis from prolonged vomiting
- Lactic acidosis due to severe volume depletion and poor tissue perfusion
Treatment Approach
- Address the underlying cause of vomiting
- Provide fluid resuscitation with appropriate electrolyte replacement
- Administer sodium bicarbonate in severe cases to correct acid-base imbalance
- Monitor electrolytes, particularly potassium, during treatment, as emphasized in 1.
In clinical practice, it is crucial to identify the specific cause of metabolic acidosis in the context of vomiting to provide targeted and effective treatment, considering the principles outlined in 1.
From the Research
Metabolic Acidosis and Vomiting
- Metabolic acidosis is not typically associated with vomiting, as vomiting usually leads to metabolic alkalosis due to the loss of hydrogen ions and chloride from the gastrointestinal tract 2, 3, 4.
- However, there are cases where metabolic acidosis can occur despite severe vomiting, and the correct diagnosis can be made using the physical-chemical approach 5.
- The causes of metabolic acidosis can be categorized into two main types: high anion gap metabolic acidosis and hyperchloremic or normal anion gap metabolic acidosis 6.
- High anion gap metabolic acidosis can occur due to the accumulation of endogenous acids, such as lactic acidosis, ketoacidosis, or renal failure, while hyperchloremic metabolic acidosis can occur due to the loss of bicarbonate from the gastrointestinal tract or the kidney 6.
- In the context of vomiting, metabolic alkalosis is more commonly expected due to the loss of hydrogen ions and chloride, but metabolic acidosis can occur in certain rare cases, such as when there is a concurrent condition that leads to acid accumulation 5.
Possible Causes of Metabolic Acidosis with Vomiting
- Concurrent conditions that lead to acid accumulation, such as lactic acidosis or ketoacidosis 6.
- Renal failure or renal tubular acidosis, which can lead to impaired acid excretion and accumulation of acid 6.
- Certain medications or toxins that can cause metabolic acidosis 6.
- Rare cases where the physical-chemical approach is necessary to correctly diagnose the underlying cause of metabolic acidosis despite vomiting 5.