Metabolic Acidosis

What is metabolic acidosis?

Metabolic acidosis is when acids build up in your body fluids.

Metabolic acidosis can develop if you have too many acids in your blood that wipe out bicarbonate (high anion gap metabolic acidosis) or if you lose too much bicarbonate in your blood as a result of kidney disease or kidney failure (normal anion gap metabolic acidosis).

Bicarbonate is a base. It’s a form of carbon dioxide — a waste byproduct after your body converts food to energy.

An anion gap is the difference between the positive and negative electric charges in the electrolytes in your blood. Electrolytes are ions that help regulate many metabolic processes in your body, such as bringing nutrients into your cells and taking waste products out of your cells. Examples of electrolytes include sodium, calcium, potassium, chloride and phosphate.

Who does metabolic acidosis affect?

Metabolic acidosis can affect anyone. However, it commonly affects people who have kidney failure (renal failure) or chronic (long-lasting) kidney disease.

What happens to your body if you have metabolic acidosis?

Your body must have a specific pH balance to function properly. The pH scale is the levels of acids and bases in your blood. The pH scale ranges from 0 (very acidic) to 14 (very basic or alkaline). A normal pH range in your blood is from 7.35 to 7.45.

Your kidneys and lungs help maintain a proper pH balance. Your kidneys remove excess acids and bases from your blood through your urine (pee). Your lungs regulate the amount of carbon dioxide in your blood.

Metabolic acidosis occurs when your body produces too much acid, or your kidneys don’t remove enough acids from your blood.

What are the signs of metabolic acidosis?

If you have metabolic acidosis, there may not be any signs or symptoms.

Common signs and symptoms of metabolic acidosis include:

• Accelerated heartbeat (tachycardia).
• Confusion or dizziness.
• Feeling very tired (fatigue).
• Loss of appetite.
• Headache.
• Rapid breathing or long, deep breathing.
• Nausea and vomiting.
• Feeling weak.
• Breath that smells sweet or fruity.

Severe cases of metabolic acidosis can cause death.

What causes metabolic acidosis?

The four leading causes of metabolic acidosis include:

• Diabetes-related acidosis. Diabetes-related acidosis develops when ketone bodies build up in your body from untreated diabetes. Your body produces ketone bodies while it turns (metabolizes) fats into energy. Your body uses ketone bodies for energy when sugars (glucose) aren’t available.
• Hyperchloremic acidosis. Hyperchloremic acidosis develops when your body loses too much sodium bicarbonate. It may occur if you take too many laxatives or have severe diarrhea.
• Lactic acidosis. Lactic acidosis develops when you have too much lactic acid in your body. Lactic acid is an organic acid that your muscle cells and red blood cells produce for energy when you don’t have a lot of oxygen in your body. Causes include liver failure, low blood sugar, alcohol use disorder, cancer and intense exercise.
• Renal tubular acidosis. Renal tubular acidosis develops when your kidneys don’t pass enough acids into your pee. As a result, your blood becomes more acidic.

What is the most common cause of metabolic acidosis?

Unmanageable diarrhea and kidney failure are the most common causes of metabolic acidosis.

Is metabolic acidosis contagious?

No, metabolic acidosis isn’t contagious. You can’t spread metabolic acidosis to another person.

How is metabolic acidosis diagnosed?

Your healthcare provider will ask you about your symptoms and may perform a physical examination. They’ll also order tests to help confirm their diagnosis. They may also refer you to a nephrologist. A nephrologist is a doctor who specializes in kidney diseases.

What tests will be done to diagnose metabolic acidosis?

Your healthcare provider may order different tests according to what they believe may be the cause of your metabolic acidosis. These tests may include:

Blood tests

Blood tests help provide important information about chemicals in your blood. Blood tests for metabolic acidosis may include:

• Anion gap. Your healthcare provider will use a thin needle to withdraw a small amount of blood from a vein in your arm. They’ll compare the difference between your blood’s positively charged electrolytes and negatively charged electrolytes. A large gap between your blood’s positive and negative electrolytes may indicate metabolic acidosis.
• Arterial blood gas (ABG). Your healthcare will use a thin needle to withdraw a small amount of blood from an artery in your wrist, arm or groin. They’ll measure the oxygen and carbon dioxide levels in your blood. They’ll also measure your blood’s pH balance. A blood pH below 7.35 indicates that you have too much acid or too little base in your blood.

Urine tests

During a urine test, you’ll pee into a special cup. Your healthcare provider will check the pH level of your pee. You may have too many acids in your pee or not enough bases in your pee.

How do you fix metabolic acidosis?

Once your healthcare provider determines what’s causing metabolic acidosis, they can recommend an appropriate treatment plan. Some treatments include:

• Sodium citrate if you have kidney disease or kidney failure.
• Fluids delivered through a vein in your arm (IV fluids).
• IV sodium bicarbonate, which helps balance the acids in your blood.
• Insulin if you have diabetes-related acidosis.
• Removing toxic substances from your blood, including aspirin, methanol (a substance in adhesives, paints and varnishes) or ethylene glycol (a substance in antifreeze).

What should I eat or drink if I have metabolic acidosis?

Certain foods and drinks can cause your body to make more acids. Before making any changes to your diet, talk to your healthcare provider. They can guide you on safely incorporating or increasing the right foods or drinks in your diet. They may also refer you to a dietitian who specializes in kidney diseases (renal dietitian).

Foods and drinks that cause your body to make acids include:

• Meats, including poultry and fish.
• Eggs.
• Cheese.
• Grains.
• Alcohol.

Foods or drinks that produce alkali include:

• Fruits.
• Nuts.
• Legumes.
• Vegetables.
• Alkaline water.

What medications are used to treat metabolic acidosis?

The over-the-counter (OTC) medications sodium citrate or sodium bicarbonate can help balance the acids in your body. Talk to your healthcare provider before taking any OTC medications to help treat your metabolic acidosis.

Your healthcare provider may also prescribe inotropes. Inotropes help your heart beat stronger, which helps get more oxygen in your body and lowers the amount of acids in your blood. Your healthcare provider can deliver inotropes to your body through an IV in a vein in your arm.

How can I reduce my risk of developing metabolic acidosis?

You can’t prevent metabolic acidosis. However, you can help reduce your risk by:

• Drinking a lot of water and other fluids.
• Managing your blood sugar levels if you have diabetes.
• Reducing the amount of alcohol that you consume. Moderate alcohol consumption in men and people assigned male at birth (AMAB) is two drinks or fewer per day. In women and people assigned female at birth (AFAB), moderate alcohol consumption is one drink or fewer per day.

What can I expect if I have metabolic acidosis?

If you have metabolic acidosis, your outlook depends on its severity and what’s causing the condition.

Many cases of metabolic acidosis respond well to treatment after a proper diagnosis.

In mild cases, your symptoms may be temporary, and you may not need treatment.

Severe cases may involve kidney or other organ failure and death.

How do I take care of myself?

Your healthcare provider will work with you to develop a treatment plan, which may include medications and changes to your lifestyle. Your treatment plan may include:

• Monitoring your blood sugar closely.
• Taking medicines as prescribed by your healthcare provider.
• Eating low-acid, high-alkali foods.
• Limiting the amount of alcohol you consume.

When should I see my healthcare provider?

Contact your healthcare provider if you have any symptoms of metabolic acidosis or symptoms of a condition that may cause metabolic acidosis.

What questions should I ask my healthcare provider?

• How do you know that I have metabolic acidosis?
• If I don’t have metabolic acidosis, what other condition might I have?
• Should I see a nephrologist or another specialist?
• What tests will you conduct to diagnose metabolic acidosis?
• How serious is my metabolic acidosis?
• What lifestyle changes can I make to improve my metabolic acidosis?
• What medications do you recommend?
• How often should I schedule appointments to monitor my condition?

What is the difference between metabolic acidosis and respiratory acidosis?

Metabolic acidosis involves your digestive system and your urinary system. Your kidneys can’t properly filter acids from your bloodstream. Kidney disease, kidney failure, untreated diabetes, loss of bicarbonate and blood poisoning may cause a more acidic pH in your body.

Respiratory acidosis involves your respiratory system. Your lungs can’t remove enough carbon dioxide from your bloodstream. Asthma, brain injuries and excessive or disordered substance use may affect your lungs’ ability to remove carbon dioxide.

A note from Cleveland Clinic

Metabolic acidosis is a condition that causes acids to build up in your body. You may try to ignore or push through some common signs of metabolic acidosis. However, they’re your body’s way of telling you something isn’t right. If you have any symptoms, speak to your healthcare provider, especially if you have any conditions that affect your kidneys. They’re here to help.