Metabolic Medicine Made Simple : Post ictal Metabolic Acidosis

Post seizure metabolic acidosis is usually the result of a grand mal / tonic clonic seizure.

Seizures result in an accelerated production of lactic acid in the muscle and reduced hepatic lactate uptake.

This post - ictal lactic acidosis is transient and usually resolves within 60 - 90 minutes.

In such patients,the most appropriate treatment is observation and repeating the chemistry panel after 2 hours to see if the acidosis has improved /resolved on its own.

If it has not resolved,it is better to look for other potential causes of metabolic acidosis.
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The common causes of ketosis include :

Diabetes

Alcoholism

Starvation

The use of bicarbonate in the treatment of lactic acidosis or ketoacidosis is very contraversial.

It is only recommended in severe acute acidosis pH < 7.2

Full correction with bicarbonate should not be sought.

Only a sufficient amount of bicarbonate should be given to correct the ph to 7.2.

In lactic acidosis,bicarbonate treatment may paradoxically depress cardiac performance and worsen the acidosis by enhancing lactate production.

Serum lipase levels are generally used to assess for pancreatic disease but may also be elevated in DKA and other conditions making the test poorly specific for any one disease process.