Electrolytes & Metabolic Medicine Made Simple : Metabolic Acidosis

Metabolic Acidosis :

Metabolic acidosis is indicated by a low pH < 7.4 and low serum bicarbonate < 24 meq / l.

There are different causes of metabolic acidosis :


Acute Renal Failure :

It occurs due to failure of the kidneys to excrete acids generated during normal protein metabolism namely inorganic phosphates and sulfates.

It may have various causes such as acute hypovolemia due to vomiting and diarrhoea , GI bleed leading to hypotension and ischemia.

Type I Renal Tubular Acidosis :

It is characterized by low tubular Ammonium production.
The primary defect in this disease is failure to excrete sufficient hydrogen ions in urine.
Without sufficient hydrogen ions in tubular fluid,ammonium cannot be produced.


Type 2 Renal tubular Acidosis :

This is characterized by defective tubular bicarbonate reabsorption .
It is often inherited and may be a components of Fanconi Syndrome.
Type II RTA can also occur with use of drugs like Carbonic Anhydrase Inhibitors.

Causes of Decreased Anion Gap Metabolic Acidosis include :

Plasma cell Dyscrasias

Lithum intoxication.

Paraproteinemias.






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