Table of ContentsView AllTable of ContentsWhat HappensCausesMost Likely CauseSymptomsDiagnosisTreatmentSelf-CareFoodsPreventionPrognosis
Table of ContentsView All
View All
Table of Contents
What Happens
Causes
Most Likely Cause
Symptoms
Diagnosis
Treatment
Self-Care
Foods
Prevention
Prognosis
Metabolic acidosis can be mild, severe, or even fatal, depending on the underlying cause. Treatments also vary and may involve nutritional approaches, medications, intensive care interventions, or some combination.
This article delves into metabolic acidosis’s biology, causes, symptoms, diagnosis, and treatment. It also briefly reviews possible preventive and self-care strategies for managing metabolic acidosis, when applicable.
Bevan Goldswain / Getty Images
What Happens to Your Body If You Have Metabolic Acidosis?
A normalblood pHis between 7.35 and 7.45, indicating a balance between bases and acids within the bloodstream.
A healthy person’s blood is also electrically neutral, meaning it is balanced between positively and negatively chargedelectrolytes(charged molecules such as sodium, potassium, bicarbonate, and chloride).
With metabolic acidosis, the blood pH and bicarbonate (the body’s main base) levels are both low.
Depending on the cause of metabolic acidosis, an imbalance in positively vs. negatively charged electrolytes may also exist.
Calculating an Electrolyte ImbalanceAnanion gap blood testcalculates the difference between charged electrolytes. Sodium and potassium are positively charged, whereas chloride and bicarbonate are negatively charged.
Calculating an Electrolyte Imbalance
Ananion gap blood testcalculates the difference between charged electrolytes. Sodium and potassium are positively charged, whereas chloride and bicarbonate are negatively charged.
Ahigh anion gap metabolic acidosismeans the pH is low and the blood is not electrically neutral. Anormal anion gap metabolic acidosismeans the pH is low, but the blood is electrically neutral.
Causes of Metabolic Acidosis
Metabolic acidosis results from one or more of the following processes:
Specific causes are then classified based on whether the anion gap is high or normal.
High Anion Gap
A high anion gap metabolic acidosis results from acid accumulation. Causes include:
Normal Anion Gap
Causes of a normal anion gap metabolic acidosis include the following:
What Is the Most Common Cause of Metabolic Acidosis?
Metabolic acidosis is a complication of many different health conditions.Lactic acidosis, ketoacidosis, and chronic kidney disease are three common causes.
Causes of lactic acidosis are many and include:
Shock is a potentially life-threatening and common cause of lactic acidosis that develops when there is a lack of oxygen reaching vital organs. Three types of shock and their meanings are:
Ketoacidosis,especially as a complication oftype 1 diabetes(diabetic ketoacidosis), is another common cause of metabolic acidosis. It can also happen with type 2 diabetes, but that is not as common.
How DKA ManifestsDiabetic ketoacidosis, or DKA, is a medical emergency that occurs when people with diabetes have insufficientinsulin—a hormone responsible for moving sugar into cells. If sugar cannot enter the cells, the body breaks down fat, producing acids called ketones.
How DKA Manifests
Diabetic ketoacidosis, or DKA, is a medical emergency that occurs when people with diabetes have insufficientinsulin—a hormone responsible for moving sugar into cells. If sugar cannot enter the cells, the body breaks down fat, producing acids called ketones.
Common triggers of DKA are:
Besides diabetes, other causes of ketoacidosis are:
Chronic kidney disease (CKD)is another cause of metabolic acidosis, particularly as the disease advances and the kidneys lose their ability to remove acids (e.g., sulfates, phosphates, and urates) from the blood.
Factors that make a person with CKD more vulnerable to developing metabolic acidosis include:
Metabolic Acidosis Symptoms
A mild metabolic acidosis often causes subtle or no symptoms. As the acidosis worsens, symptoms such as the following may develop:
In severe cases, heart problems may arise, including abnormal heart rhythms, low blood pressure, shock,coma, and death.
Depending on the underlying cause, additional symptoms of metabolic acidosis can also be present. For example, a fruity breath odor and increased thirst/urination are symptoms of diabetic ketoacidosis.Low blood pressure, fever, and warm skin are symptoms/signs of septic shock.
How Metabolic Acidosis Is Diagnosed
Metabolic acidosis is diagnosed through these two blood tests:
Other blood and urine tests can help determine the cause of the metabolic acidosis.
Blood tests may include:
Some blood tests, namely toxins like blood methanol or ethylene glycol levels, are collected in a hospital and sent to the lab for analysis.
Urine tests may include:
How Metabolic Acidosis Is Treated
The treatment of metabolic acidosis is aimed at managing the underlying cause.
Examples of specific therapies include:
Self-Care Strategies for Metabolic Acidosis
Self-care strategies are also often part of the treatment plan to manage chronic metabolic acidosis (e.g., from kidney disease) or after recovering from acute metabolic acidosis.
As an example, nutritional guidance and supplements to lower the blood’s acid levels (e.g.,sodium bicarbonateor potassium citrate) are often recommended in people with chronic kidney disease.
Likewise, after leaving the hospital for diabetic ketoacidosis, a person’s healthcare provider may advise ketone monitoring at home, stricter blood glucose testing, and following a more consistent carbohydrate diet.
Blood Ketone Meters: How to Test at Home
What Foods Are Good for Metabolic Acidosis?
Foods that can help lower the acidity of the blood include:
Conversely, foods that are acid-forming when digested and, therefore, should be limited or moderated include:
Seeing a Kidney DietitianA registered dietitian specializing in renal (kidney) nutrition can help you or a loved one create a personalized eating plan. They will consider factors like:Stage of your kidney diseaseFood preferencesPresence of other health conditions
Seeing a Kidney Dietitian
A registered dietitian specializing in renal (kidney) nutrition can help you or a loved one create a personalized eating plan. They will consider factors like:Stage of your kidney diseaseFood preferencesPresence of other health conditions
A registered dietitian specializing in renal (kidney) nutrition can help you or a loved one create a personalized eating plan. They will consider factors like:
How to Prevent Metabolic Acidosis
Preventing metabolic acidosis is not always possible.
However, engaging in healthy self-care strategies can help prevent conditions that may lead to metabolic acidosis, like widespread infection, cancer, or kidney failure.
Some of these strategies include:
What to Expect If You Have Metabolic Acidosis
Regardless of the cause, metabolic acidosis requires close follow-up.
Theprognosis(disease outcome) of metabolic acidosis depends largely on its cause and severity.
Milder cases, though, can often be managed well, if not possibly reversed with the appropriate therapies.
Unfortunately, persistent or long-term metabolic acidosis can lead to various complications, such as muscle wasting and bone thinning (osteoporosis).
Summary
Excess bicarbonate loss through the stool (severe diarrhea) or urine (renal tubular acidosis) can cause a normal anion gap acidosis.
Diagnosis of metabolic acidosis involves two primary blood tests: an arterial blood gas to detect a low pH and a basic metabolic panel to detect a low bicarbonate level. Treatment and disease outcome depend on the underlying cause and other factors, such as the severity and speed of onset if acidosis.
If you have concerns about developing metabolic acidosis, speak with a healthcare provider. Prompt detection is crucial to reversing or optimizing the management of this complex blood disturbance.
19 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Emmett M, Szerlip H.Approach to the adult with metabolic acidosis. In: UpToDate, Sterns RH, Kelepouris E (Eds), Wolters Kluwer. September 8, 2023.Matyukhin I, Patschan S, Ritter O, Patschan D.Etiology and management of acute metabolic acidosis: an update.Kidney Blood Press Res. 2020;45(4):523-531. doi:10.1159/000507813Lewis III JL.Metabolic acidosis. InMerck Manual Professional Version. Merck & Co., Inc. July 2023.Palmer BF, Clegg DJ.Hyperchloremic normal gap metabolic acidosis.Minerva Endocrinol. 2019;44(4):363-377. doi:10.23736/S0391-1977.19.03059-1Stein R, Rubenwolf P.Metabolic consequences after urinary diversion.Front Pediatr. 2014;2:15. doi:10.3389/fped.2014.00015Standl T, Annecke T, Cascorbi I, Heller AR, Sabashnikov A, Teske W.The nomenclature, definition and distinction of types of shock.Dtsch Arztebl Int. 2018;115(45):757-768. doi:10.3238/arztebl.2018.0757Vahdatpour C, Collins D, Goldberg S.Cardiogenic shock.J Am Heart Assoc. 2019;8(8):e011991. doi:10.1161/JAHA.119.011991Eledrisi MS, Elzouki AN.Management of diabetic ketoacidosis in adults: a narrative review.Saudi J Med Med Sci. 2020;8(3):165-173. doi:10.4103/sjmms.sjmms_478_19National Kidney Foundation.Metabolic acidosis.Shahid W, Khan F, Makda A, Kumar V, Memon S, Rizwan A.Diabetic ketoacidosis: clinical characteristics and precipitating factors.Cureus. 2020;12(10):e10792. doi:10.7759/cureus.10792Basodan N, Al Mehmadi AE, Al Mehmadi AE, et al.Septic shock: management and outcomes.Cureus. 2022;14(12):e32158. doi:10.7759/cureus.32158Centers for Disease Control and Prevention.Ethylene Glycol and Propylene Glycol Toxicity: Clinical Assessment-Laboratory Tests. October 6, 2022.Mandal M.Ideal resuscitation fluid in hypovolemia: the quest is on and miles to go!Int J Crit Illn Inj Sci. 2016;6(2):54-5. doi:10.4103/2229-5151.183020Francis GS, Bartos JA, Adatya S.Inotropes.Journal of the American College of Cardiology. 2014;63(20):2069-2078. doi:10.1016/j.jacc.2014.01.016Beaulieu J, Roberts DM, Gosselin S, et al.Treating ethylene glycol poisoning with alcohol dehydrogenase inhibition, but without extracorporeal treatments: a systematic review.Clin Toxicol (Phila). 2022;60(7):784-797. doi:10.1080/15563650.2022.2049810Akchurin OM.Chronic kidney disease and dietary measures to improve outcomes.Pediatr Clin North Am. 2019;66(1):247-267. doi:10.1016/j.pcl.2018.09.007Noce A, Marrone G, Wilson Jones G, et al.Nutritional approaches for the management of metabolic acidosis in chronic kidney disease.Nutrients. 2021;13(8):2534. doi:10.3390/nu13082534Yagi K, Fujii T.Management of acute metabolic acidosis in the ICU: sodium bicarbonate and renal replacement therapy.Crit Care, 2021;25:314 (2021). doi:10.1186/s13054-021-03677-4Raphael KL.Approach to the treatment of chronic metabolic acidosis in CKD.Am J Kidney Dis. 2016;67(4):696-702. doi:10.1053/j.ajkd.2015.12.016
19 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Emmett M, Szerlip H.Approach to the adult with metabolic acidosis. In: UpToDate, Sterns RH, Kelepouris E (Eds), Wolters Kluwer. September 8, 2023.Matyukhin I, Patschan S, Ritter O, Patschan D.Etiology and management of acute metabolic acidosis: an update.Kidney Blood Press Res. 2020;45(4):523-531. doi:10.1159/000507813Lewis III JL.Metabolic acidosis. InMerck Manual Professional Version. Merck & Co., Inc. July 2023.Palmer BF, Clegg DJ.Hyperchloremic normal gap metabolic acidosis.Minerva Endocrinol. 2019;44(4):363-377. doi:10.23736/S0391-1977.19.03059-1Stein R, Rubenwolf P.Metabolic consequences after urinary diversion.Front Pediatr. 2014;2:15. doi:10.3389/fped.2014.00015Standl T, Annecke T, Cascorbi I, Heller AR, Sabashnikov A, Teske W.The nomenclature, definition and distinction of types of shock.Dtsch Arztebl Int. 2018;115(45):757-768. doi:10.3238/arztebl.2018.0757Vahdatpour C, Collins D, Goldberg S.Cardiogenic shock.J Am Heart Assoc. 2019;8(8):e011991. doi:10.1161/JAHA.119.011991Eledrisi MS, Elzouki AN.Management of diabetic ketoacidosis in adults: a narrative review.Saudi J Med Med Sci. 2020;8(3):165-173. doi:10.4103/sjmms.sjmms_478_19National Kidney Foundation.Metabolic acidosis.Shahid W, Khan F, Makda A, Kumar V, Memon S, Rizwan A.Diabetic ketoacidosis: clinical characteristics and precipitating factors.Cureus. 2020;12(10):e10792. doi:10.7759/cureus.10792Basodan N, Al Mehmadi AE, Al Mehmadi AE, et al.Septic shock: management and outcomes.Cureus. 2022;14(12):e32158. doi:10.7759/cureus.32158Centers for Disease Control and Prevention.Ethylene Glycol and Propylene Glycol Toxicity: Clinical Assessment-Laboratory Tests. October 6, 2022.Mandal M.Ideal resuscitation fluid in hypovolemia: the quest is on and miles to go!Int J Crit Illn Inj Sci. 2016;6(2):54-5. doi:10.4103/2229-5151.183020Francis GS, Bartos JA, Adatya S.Inotropes.Journal of the American College of Cardiology. 2014;63(20):2069-2078. doi:10.1016/j.jacc.2014.01.016Beaulieu J, Roberts DM, Gosselin S, et al.Treating ethylene glycol poisoning with alcohol dehydrogenase inhibition, but without extracorporeal treatments: a systematic review.Clin Toxicol (Phila). 2022;60(7):784-797. doi:10.1080/15563650.2022.2049810Akchurin OM.Chronic kidney disease and dietary measures to improve outcomes.Pediatr Clin North Am. 2019;66(1):247-267. doi:10.1016/j.pcl.2018.09.007Noce A, Marrone G, Wilson Jones G, et al.Nutritional approaches for the management of metabolic acidosis in chronic kidney disease.Nutrients. 2021;13(8):2534. doi:10.3390/nu13082534Yagi K, Fujii T.Management of acute metabolic acidosis in the ICU: sodium bicarbonate and renal replacement therapy.Crit Care, 2021;25:314 (2021). doi:10.1186/s13054-021-03677-4Raphael KL.Approach to the treatment of chronic metabolic acidosis in CKD.Am J Kidney Dis. 2016;67(4):696-702. doi:10.1053/j.ajkd.2015.12.016
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Emmett M, Szerlip H.Approach to the adult with metabolic acidosis. In: UpToDate, Sterns RH, Kelepouris E (Eds), Wolters Kluwer. September 8, 2023.Matyukhin I, Patschan S, Ritter O, Patschan D.Etiology and management of acute metabolic acidosis: an update.Kidney Blood Press Res. 2020;45(4):523-531. doi:10.1159/000507813Lewis III JL.Metabolic acidosis. InMerck Manual Professional Version. Merck & Co., Inc. July 2023.Palmer BF, Clegg DJ.Hyperchloremic normal gap metabolic acidosis.Minerva Endocrinol. 2019;44(4):363-377. doi:10.23736/S0391-1977.19.03059-1Stein R, Rubenwolf P.Metabolic consequences after urinary diversion.Front Pediatr. 2014;2:15. doi:10.3389/fped.2014.00015Standl T, Annecke T, Cascorbi I, Heller AR, Sabashnikov A, Teske W.The nomenclature, definition and distinction of types of shock.Dtsch Arztebl Int. 2018;115(45):757-768. doi:10.3238/arztebl.2018.0757Vahdatpour C, Collins D, Goldberg S.Cardiogenic shock.J Am Heart Assoc. 2019;8(8):e011991. doi:10.1161/JAHA.119.011991Eledrisi MS, Elzouki AN.Management of diabetic ketoacidosis in adults: a narrative review.Saudi J Med Med Sci. 2020;8(3):165-173. doi:10.4103/sjmms.sjmms_478_19National Kidney Foundation.Metabolic acidosis.Shahid W, Khan F, Makda A, Kumar V, Memon S, Rizwan A.Diabetic ketoacidosis: clinical characteristics and precipitating factors.Cureus. 2020;12(10):e10792. doi:10.7759/cureus.10792Basodan N, Al Mehmadi AE, Al Mehmadi AE, et al.Septic shock: management and outcomes.Cureus. 2022;14(12):e32158. doi:10.7759/cureus.32158Centers for Disease Control and Prevention.Ethylene Glycol and Propylene Glycol Toxicity: Clinical Assessment-Laboratory Tests. October 6, 2022.Mandal M.Ideal resuscitation fluid in hypovolemia: the quest is on and miles to go!Int J Crit Illn Inj Sci. 2016;6(2):54-5. doi:10.4103/2229-5151.183020Francis GS, Bartos JA, Adatya S.Inotropes.Journal of the American College of Cardiology. 2014;63(20):2069-2078. doi:10.1016/j.jacc.2014.01.016Beaulieu J, Roberts DM, Gosselin S, et al.Treating ethylene glycol poisoning with alcohol dehydrogenase inhibition, but without extracorporeal treatments: a systematic review.Clin Toxicol (Phila). 2022;60(7):784-797. doi:10.1080/15563650.2022.2049810Akchurin OM.Chronic kidney disease and dietary measures to improve outcomes.Pediatr Clin North Am. 2019;66(1):247-267. doi:10.1016/j.pcl.2018.09.007Noce A, Marrone G, Wilson Jones G, et al.Nutritional approaches for the management of metabolic acidosis in chronic kidney disease.Nutrients. 2021;13(8):2534. doi:10.3390/nu13082534Yagi K, Fujii T.Management of acute metabolic acidosis in the ICU: sodium bicarbonate and renal replacement therapy.Crit Care, 2021;25:314 (2021). doi:10.1186/s13054-021-03677-4Raphael KL.Approach to the treatment of chronic metabolic acidosis in CKD.Am J Kidney Dis. 2016;67(4):696-702. doi:10.1053/j.ajkd.2015.12.016
Emmett M, Szerlip H.Approach to the adult with metabolic acidosis. In: UpToDate, Sterns RH, Kelepouris E (Eds), Wolters Kluwer. September 8, 2023.
Matyukhin I, Patschan S, Ritter O, Patschan D.Etiology and management of acute metabolic acidosis: an update.Kidney Blood Press Res. 2020;45(4):523-531. doi:10.1159/000507813
Lewis III JL.Metabolic acidosis. InMerck Manual Professional Version. Merck & Co., Inc. July 2023.
Palmer BF, Clegg DJ.Hyperchloremic normal gap metabolic acidosis.Minerva Endocrinol. 2019;44(4):363-377. doi:10.23736/S0391-1977.19.03059-1
Stein R, Rubenwolf P.Metabolic consequences after urinary diversion.Front Pediatr. 2014;2:15. doi:10.3389/fped.2014.00015
Standl T, Annecke T, Cascorbi I, Heller AR, Sabashnikov A, Teske W.The nomenclature, definition and distinction of types of shock.Dtsch Arztebl Int. 2018;115(45):757-768. doi:10.3238/arztebl.2018.0757
Vahdatpour C, Collins D, Goldberg S.Cardiogenic shock.J Am Heart Assoc. 2019;8(8):e011991. doi:10.1161/JAHA.119.011991
Eledrisi MS, Elzouki AN.Management of diabetic ketoacidosis in adults: a narrative review.Saudi J Med Med Sci. 2020;8(3):165-173. doi:10.4103/sjmms.sjmms_478_19
National Kidney Foundation.Metabolic acidosis.
Shahid W, Khan F, Makda A, Kumar V, Memon S, Rizwan A.Diabetic ketoacidosis: clinical characteristics and precipitating factors.Cureus. 2020;12(10):e10792. doi:10.7759/cureus.10792
Basodan N, Al Mehmadi AE, Al Mehmadi AE, et al.Septic shock: management and outcomes.Cureus. 2022;14(12):e32158. doi:10.7759/cureus.32158
Centers for Disease Control and Prevention.Ethylene Glycol and Propylene Glycol Toxicity: Clinical Assessment-Laboratory Tests. October 6, 2022.
Mandal M.Ideal resuscitation fluid in hypovolemia: the quest is on and miles to go!Int J Crit Illn Inj Sci. 2016;6(2):54-5. doi:10.4103/2229-5151.183020
Francis GS, Bartos JA, Adatya S.Inotropes.Journal of the American College of Cardiology. 2014;63(20):2069-2078. doi:10.1016/j.jacc.2014.01.016
Beaulieu J, Roberts DM, Gosselin S, et al.Treating ethylene glycol poisoning with alcohol dehydrogenase inhibition, but without extracorporeal treatments: a systematic review.Clin Toxicol (Phila). 2022;60(7):784-797. doi:10.1080/15563650.2022.2049810
Akchurin OM.Chronic kidney disease and dietary measures to improve outcomes.Pediatr Clin North Am. 2019;66(1):247-267. doi:10.1016/j.pcl.2018.09.007
Noce A, Marrone G, Wilson Jones G, et al.Nutritional approaches for the management of metabolic acidosis in chronic kidney disease.Nutrients. 2021;13(8):2534. doi:10.3390/nu13082534
Yagi K, Fujii T.Management of acute metabolic acidosis in the ICU: sodium bicarbonate and renal replacement therapy.Crit Care, 2021;25:314 (2021). doi:10.1186/s13054-021-03677-4
Raphael KL.Approach to the treatment of chronic metabolic acidosis in CKD.Am J Kidney Dis. 2016;67(4):696-702. doi:10.1053/j.ajkd.2015.12.016
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