METABOLIC ACIDOSIS : INVESTIGATIONS & MANAGEMENT

METABOLIC ACIDOSIS : INVESTIGATIONS & MANAGEMENT :

INVESTIGATIONS

These tests can help diagnose acidosis. They can also determine whether the cause is a breathing problem or a metabolic problem. Tests may include:

Arterial blood gas

Basic metabolic panel, (a group of blood tests that measure your sodium and potassium levels, kidney function, and other chemicals and functions)

Blood ketones

Lactic acid test

Urine ketones

Urine pH

Other tests may be needed to determine the cause of the acidosis.

MANAGEMENT OF METABOLIC ACIDOSIS

Treatment of metabolic acidosis depends on the underlying cause, and should target reversing the main process.

When considering course of treatment, it is important to distinguish between acute versus chronic forms.

Bicarbonate therapy is generally administered In patients with severe acute acidemia (pH < 7.11), or with less severe acidemia (pH 7.1-7.2) who have severe acute kidney injury.

Bicarbonate therapy is not recommended for people with less severe acidosis (pH ≥ 7.1), unless severe acute kidney injury is present.

In the BICAR-ICU trial,bicarbonate therapy for maintaining a pH >7.3 had no overall effect on the composite outcome of all-cause mortality and the presence of at least one organ failure at day 7.

However, amongst the sub-group of patients with severe acute kidney injury, bicarbonate therapy significantly decreased the primary composite outcome, and 28-day mortality, along with the need for dialysis.

Currently, the most commonly used treatment for chronic metabolic acidosis is oral bicarbonate.

The NKF/KDOQI guidelines recommend starting treatment when serum bicarbonate levels are <22 mEq/L, in order to maintain levels ≥ 22 mEq/L.

Studies investigating the effects of oral alkali therapy demonstrated improvements in serum bicarbonate levels, resulting in a slower decline in kidney function, and reduction in proteinuria – leading to a reduction in the risk of progressing to kidney failure.

However, side effects of oral alkali therapy include gastrointestinal intolerance, worsening edema, and worsening hypertension.

Furthermore, large doses of oral alkali are required to treat chronic metabolic acidosis, and the pill burden can limit adherence.

Veverimer (TRC 101) is a promising investigational drug designed to treat metabolic acidosis by binding with the acid in the gastrointestinal tract and removing it from the body through excretion in the feces, in turn decreasing the amount of acid in the body, and increasing the level of bicarbonate in the blood.