Metabolic acidosis natural history, complications and prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Prognosis and recovery of Metabolic Acidosis is dependent on the causative factor. Appropriate and timely treatment takes time but help in recovery. Some people totally recover from Metabolic Acidosis whereas others may develop

• Cardiovascular System: Decrease contractility, Arterial vasodilatation, Decrease Mean Arterial Pressure, Decrease Cardiac Output, Decrease response to Catecholamine, Increase risk of arrhythmias
• Respiratory System: Hyperventilation(compensatory), Decrease Respiratory Muscle Strength, Metabolic Acidosis Increase Potassium(Due to H+/K+ pump exchanging excess H+ with Intracellular K+)
• Neurological: Altered Mental Status, lethargy

• Multiple organ dysfunction
• Renal System: Renal failure, Kidney stones
• Musculoskeletal: Bone disease, delayed growth
• severe acidosis can also result in shock and rarely death
• Glucose tolerance can be impaired because of interference with the actions of insulin
• predisposes patients to amyloidosis because of production Beta 2 micro globulins.

COMPLICATIONS FROM USE OF BICARBONATES:

Caution with bicarbonate therapy is indicated because of its potential complications, including the following:

• Volume overload
• Hypokalemia
• CNS acidosis
• Hypercapnia
• Tissue hypoxia via leftward shift of hemoglobin-oxygen dissociation curve
• Alkali stimulation of organic acidosis (lactate)
• Overshoot alkalosis

PROGNOSIS:

The prognosis is directly related to the underlying etiology and the ability to treat or correct that particular disorder.

• A study in 2016 indicated that in patients undergoing renal replacement therapy, an association exists between uncorrected severe metabolic acidosis (serum bicarbonate concentrations of below 20 mmol/L) and a 10-year risk for coronary heart disease of over 20%, as well as a high overall mortality rate.^[1]
• A study in 2017 indicated that a high rate of metabolic acidosis occurs in kidney transplant recipients; a low serum total CO₂ concentration (< 22 mmol/L) was found in about 30-70% of such patients with an estimated glomerular filtration rate of under 30 mL/min per 1.73 m². The study also found evidence that metabolic acidosis may increase the likelihood of mortality in kidney transplant recipients^[2] and graft failure.
• In a study of emergency department patients with acute kidney injury, metabolic acidosis is independently associated with mortality, along with sex, age over 60 years, blood urea nitrogen (BUN) concentration, hyperkalemia, cause of renal failure, and type of renal failure. ^[3]

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