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Metabolic acidosis is a serious electrolyte disorder characterized by an imbalance in the body's acid-base balance.Metabolic acidosis has three main root causes: increased acid production, loss of bicarbonate, and a reduced ability of the kidneys to excrete excess acids. [5]
The bicarbonate buffer system is an acid-base homeostatic mechanism involving the balance of carbonic acid (H 2 CO 3), bicarbonate ion (HCO − 3 ), and carbon dioxide (CO 2 ) in order to maintain pH in the blood and duodenum , among other tissues, to support proper metabolic function. [ 1 ]
The kidneys only partially compensate, so the patient may still have a low blood pH, i.e. acidemia. In summary, the kidneys partially compensate for respiratory acidosis by raising blood bicarbonate. A high base excess, thus metabolic alkalosis, usually involves an excess of bicarbonate. It can be caused by
The bicarbonate ion (hydrogencarbonate ion) is an anion with the empirical formula HCO − 3 and a molecular mass of 61.01 daltons; it consists of one central carbon atom surrounded by three oxygen atoms in a trigonal planar arrangement, with a hydrogen atom attached to one of the oxygens.
Metabolic alkalosis is an acid-base disorder in which the pH of tissue is elevated beyond the normal range (7.35–7.45). This is the result of decreased hydrogen ion concentration, leading to increased bicarbonate (HCO − 3), or alternatively a direct result of increased bicarbonate concentrations.
Circulating hydrogen ions and bicarbonate are shifted through the carbonic acid (H 2 CO 3) intermediate to make more CO 2 via the enzyme carbonic anhydrase according to the following reaction: + + + This causes decreased circulating hydrogen ion concentration, and increased pH (alkalosis).
Diagnosis of contraction alkalosis is made by correlating laboratory data with clinical history and examination. Metabolic alkalosis in the presence of decreased effective circulatory volume, loop diuretic use, or other causes of intravascular depletion such as profound diarrhea should raise suspicion for contraction alkalosis as a likely etiology in the absence of other causes.
In those with severely low blood pH who are critically ill, sodium bicarbonate may be given; however, its use is of unclear benefit and typically not recommended. [1] [6] Rates of DKA vary around the world. [5] Each year, about 4% of type 1 diabetics in the United Kingdom develop DKA, versus 25% of type 1 diabetics in Malaysia.