What are the most common symptoms of Metabolic Acidosis?

From the Guidelines

Metabolic acidosis is characterized by symptoms such as nausea, vomiting, Kussmaul respirations, dehydration, and altered mental status, as seen in diabetic ketoacidosis 1. These symptoms are a result of the body's attempt to compensate for excess acid by increasing respiratory rate to eliminate carbon dioxide, and the impact of acidosis on multiple organ systems, particularly the central nervous system and cardiovascular system. The severity of symptoms generally correlates with the degree of acidosis, with more severe acidosis associated with more severe manifestations, including cardiac arrhythmias and shock. Early recognition of these symptoms is crucial as untreated severe metabolic acidosis can progress to coma and death. Treatment focuses on addressing the underlying cause while supporting vital functions, and may include intravenous fluids, insulin for diabetic ketoacidosis, or sodium bicarbonate in certain situations, as outlined in recent guidelines for diabetes care in the hospital 1. Some key points to consider in the management of metabolic acidosis include:

• Restoration of circulatory volume and tissue perfusion
• Resolution of hyperglycemia
• Correction of electrolyte imbalance and acidosis
• Treatment of any underlying cause of the condition, such as sepsis, myocardial infarction, or stroke 1. It is essential to individualize treatment based on a careful clinical and laboratory assessment, considering the variability in presentation of diabetic ketoacidosis and hyperosmolar hyperglycemic states 1.

From the Research

Metabolic Acidosis Symptoms

• The most common symptoms of metabolic acidosis can vary depending on the underlying cause, but some common symptoms include:
  • Hyperventilation (Kussmaul's respiration) 2
  • Fruity odor of acetone on the patient's breath 2
  • Polyuria, polydipsia, and weight loss (classical triad of symptoms associated with hyperglycemia) 2
  • Circulatory insufficiency with hypotension 2
  • Neurologic abnormalities, including lethargy, seizures, or coma 2
  • Vomiting and abdominal pain 2
• In diabetic ketoacidosis (DKA), a form of metabolic acidosis, the symptoms may include:
  • Hyperglycemia, ketosis, and anion gap metabolic acidosis 3, 4
  • Dehydration and electrolyte imbalances 3
• The symptoms of metabolic acidosis can be acute or chronic, and the underlying cause may be related to:
  • Overproduction of organic acids such as ketoacids or lactic acid 5
  • Bicarbonate wasting and/or impaired renal acidification 5

Diagnosis and Treatment

• The diagnosis of metabolic acidosis is typically made by measuring the plasma glucose concentration, detecting glucosuria and ketonuria, and performing blood gas analysis and anion gap calculations 2, 5
• The treatment of metabolic acidosis depends on the underlying cause, but may include:
  • Restoration of circulating volume and insulin therapy 3
  • Electrolyte replacement and treatment of any underlying precipitating event 3
  • Administration of base to treat chronic metabolic acidosis, although this is controversial for acute metabolic acidosis 5