Metabolic acidosis resident survival guide

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ogheneochuko Ajari, MB.BS, MS [2]

Definition

Metabolic acidosis is a state in which the blood pH is low (less than 7.35) due to increased production of H⁺ by the body or the inability of the body to form bicarbonate (HCO₃^-) in the kidney.

Causes

Life Threatening Causes

Common Causes

Low Anion Gap

Normal Anion Gap Metabolic Acidosis

The mnemonic for the most common causes of a normal-anion gap metabolic acidosis is "DURHAM."

D- Diarrhea
U- Ureteral diversion
R- Renal tubular acidosis
H- Hyperalimentation
A- Addison's disease, acetazolamide, ammonium chloride
M- Miscellaneous (congenital chloride diarrhea, amphotericin B, toluene - toluene causes high anion gap metabolic acidosis followed by normal anion gap metabolic acidosis

Increased/High Anion Gap Metabolic Acidosis

The mnemonic "MUDPILES" is used to remember the common causes of a high anion gap.

Management

Shown below is the algorithm summarizing the management of metabolic acidosis

B01

C01

C02

C03

D01

D02

D03

D04

D05

E01

E02

Do's

Treatment of the underlying cause should be the primary therapeutic goal.
Bicarbonate should be given only when there is a severe case of acidosis with an arterial pH of less than or equal to 7.0
Patient should be placed on SaO2 and blood pressure/heart rate monitor
Consider intubation and ventilation for airway if the SaO2 level is deteriorating or there is a loss of consciousness
Consider doing catherization to monitor the urine output and obtaining urine for urinalysis

Dont's

Do not give vasoconstrictors in the presence of lactic acidosis

References

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