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Swiss Medical Weekly Mar 2001Metabolic acidosis is an important acid-base disturbance in humans. It is characterised by a primary decrease in body bicarbonate stores and is known to induce multiple... (Review)
Review
Metabolic acidosis is an important acid-base disturbance in humans. It is characterised by a primary decrease in body bicarbonate stores and is known to induce multiple endocrine and metabolic alterations. Metabolic acidosis induces nitrogen wasting and, in humans, depresses protein metabolism. The acidosis-induced alterations in various endocrine systems include decreases in IGF-1 levels due to peripheral growth hormone insensitivity, a mild form of primary hypothyroidism and hyperglucocorticoidism. Metabolic acidosis induces a negative calcium balance (resorption from bone) with hypercalciuria and a propensity to develop kidney stones. Metabolic acidosis also results in hypophosphataemia due to renal phosphate wasting. Negative calcium balance and phosphate depletion combine to induce a metabolic bone disease that exhibits features of both osteoporosis and osteomalacia. In humans at least, 1,25-(OH)2 vitamin D levels increase, probably through phosphate depletion-induced stimulation of 1-alpha hydroxylase. The production rate of 1,25-(OH)2 vitamin D is thus stimulated, and parathyroid hormone decreases secondarily. There is experimental evidence to support the notion that even mild degrees of acidosis, such as that occurring by ingestion of a high animal protein diet, induces some of these metabolic and endocrine effects. The possible role of diet-induced acid loads in nephrolithiasis, age-related loss of lean body mass and osteoporosis is discussed.
Topics: Acidosis; Diet; Endocrine Glands; Ergocalciferols; Growth Hormone; Humans; Nitrogen; Parathyroid Hormone; Proteins
PubMed: 11416968
DOI: 10.4414/smw.2001.09666 -
British Journal of Hospital Medicine... Aug 2022Metabolic acidosis is a common complication among acutely unwell hospitalised patients. Untreated, it can result in undesirable cardiovascular, respiratory and...
Metabolic acidosis is a common complication among acutely unwell hospitalised patients. Untreated, it can result in undesirable cardiovascular, respiratory and neurological consequences. Metabolic acidosis can occur as an isolated entity or coexist with other acid-base disorders, making diagnosing the aetiology difficult. Accurate identification of the underlying cause is imperative for proper and timely management. A systematic approach can help simplify the assessment of patients and can aid in establishing the correct diagnosis, even in more complex cases. This article provides a practical, step-by-step guide for the assessment of adult patients with metabolic acidosis.
Topics: Acid-Base Equilibrium; Acidosis; Adult; Humans
PubMed: 36066292
DOI: 10.12968/hmed.2021.0582 -
Journal of Nephrology 2006Acid-base balance is precisely regulated by pulmonary and renal responses while body buffers help to control pH. When its regulation becomes abnormal, accumulation of... (Review)
Review
Acid-base balance is precisely regulated by pulmonary and renal responses while body buffers help to control pH. When its regulation becomes abnormal, accumulation of hydrogen ions cause metabolic acidosis and several responses are activated. These responses interfere with the metabolism of bones and muscle. Metabolic acidosis induces abnormalities in the release and function of several hormones including defects in growth hormone, IGF-1, insulin, glucocorticoids, thyroid hormone, parathyroid hormone and vitamin D. Clinical consequences of these abnormal metabolic responses include impaired growth of infants and children and loss of bone and muscle mass in adults. Notably, abnormalities in bone and muscle metabolism can be present even when there is little or no decrease in the plasma bicarbonate concentration. The abnormalities can be corrected by treatment with NaHCO 3 . In patients with chronic kidney disease, many abnormalities in bone and muscle metabolism can be directly linked to the presence of metabolic acidosis and these abnormalities can be largely corrected by treating acidosis with NaHCO3. Recent insights indicate that several consequences of metabolic acidosis including the development of insulin resistance can stimulate muscle protein degradation by activating proteolytic mechanisms. To avoid abnormalities in metabolism and the loss of bone and muscle, metabolic acidosis must be corrected in normal adults and in patients with kidney disease.
Topics: Acid-Base Equilibrium; Acidosis; Amino Acids; Bone Diseases, Metabolic; Humans; Kidney Diseases; Risk Factors
PubMed: 16736444
DOI: No ID Found -
Emergency Medicine Clinics of North... May 2014Acid-base disorders should be considered a process with the goal being to treat the patient and the underlying condition, not the numbers. A good understanding of the... (Review)
Review
Acid-base disorders should be considered a process with the goal being to treat the patient and the underlying condition, not the numbers. A good understanding of the normal acid-base regulation in the body, as well as the most common derangements can prepare the emergency physician for this very common disorder that presents on every shift.
Topics: Acid-Base Imbalance; Acidosis; Disease Management; Emergency Service, Hospital; Humans
PubMed: 24766940
DOI: 10.1016/j.emc.2014.01.002 -
NeoReviews Nov 2022
Topics: Humans; Hypothermia; Acidosis; Hypothermia, Induced
PubMed: 36316256
DOI: 10.1542/neo.23-10-e778 -
Nature Reviews. Nephrology Oct 2012Acute metabolic acidosis is associated with increased morbidity and mortality because of its depressive effects on cardiovascular function, facilitation of cardiac... (Review)
Review
Acute metabolic acidosis is associated with increased morbidity and mortality because of its depressive effects on cardiovascular function, facilitation of cardiac arrhythmias, stimulation of inflammation, suppression of the immune response, and other adverse effects. Appropriate evaluation of acute metabolic acidosis includes assessment of acid-base parameters, including pH, partial pressure of CO(2) and HCO(3)(-) concentration in arterial blood in stable patients, and also in central venous blood in patients with impaired tissue perfusion. Calculation of the serum anion gap and the change from baseline enables the physician to detect organic acidoses, a common cause of severe metabolic acidosis, and aids therapeutic decisions. A fall in extracellular and intracellular pH can affect cellular function via different mechanisms and treatment should be directed at improving both parameters. In addition to supportive measures, treatment has included administration of base, primarily in the form of sodium bicarbonate. However, in clinical studies of lactic acidosis and ketoacidosis, bicarbonate administration has not reduced morbidity or mortality, or improved cellular function. Potential explanations for this failure include exacerbation of intracellular acidosis, reduction in ionized Ca(2+), and production of hyperosmolality. Administration of tris(hydroxymethyl)aminomethane (THAM) improves acidosis without producing intracellular acidosis and its value as a form of base is worth further investigation. Selective sodium-hydrogen exchanger 1 (NHE1) inhibitors have been shown to improve haemodynamics and reduce mortality in animal studies of acute lactic acidosis and should also be examined further. Given the important effects of acute metabolic acidosis on clinical outcomes, more intensive study of the pathogenesis of the associated cellular dysfunction and novel methods of treatment is indicated.
Topics: Acidosis; Acute Disease; Blood Gas Analysis; Hemodynamics; Humans; Hydrogen-Ion Concentration; Sodium-Hydrogen Exchangers; Treatment Outcome
PubMed: 22945490
DOI: 10.1038/nrneph.2012.186 -
MedEdPORTAL : the Journal of Teaching... Sep 2019Metabolic acidosis is a dangerous and potentially life-threatening condition encountered in the inpatient and emergency department setting. Metabolic acidoses due to... (Comparative Study)
Comparative Study
INTRODUCTION
Metabolic acidosis is a dangerous and potentially life-threatening condition encountered in the inpatient and emergency department setting. Metabolic acidoses due to renal failure, bicarbonate losses, or lactic acidosis are common conditions, and the appropriate medical management of each is relevant to any inpatient medical provider. Therefore, we created a learning activity that utilizes blackboard-style videos followed by an interactive case-based learning session to help the medical student recognize, diagnose, and manage common causes of metabolic acidosis.
METHODS
We organized this learning activity by assigning digital videos, followed by application in an interactive team-based format. We created electronic blackboard-style videos and a quiz to assess medical knowledge related to concepts discussed in the videos. Next, we created case resources that facilitate an interactive case-based teaching session so the learners could apply their knowledge and simulate the management of metabolic acidosis.
RESULTS
We implemented this activity for 34 medical students. All students viewed the videos prior to the in-class session. In a pre/post assessment of medical knowledge, we observed a significant improvement in quiz scores. Next, we successfully facilitated the case-based active learning session, allowing the assessment of higher-order cognitive skills related to management of patients with metabolic acidosis. Our medical students felt highly satisfied and competent at the completion of our course.
DISCUSSION
Our medical students rated this as an excellent learning activity. Others may find this activity useful within the context of any course or rotation related to patients with metabolic acidosis.
Topics: Acid-Base Imbalance; Acidosis; Acidosis, Lactic; Bicarbonates; Critical Care; Education, Medical, Undergraduate; Educational Measurement; Emergency Medicine; Health Knowledge, Attitudes, Practice; Humans; Inpatients; Personal Satisfaction; Problem-Based Learning; Renal Insufficiency; Simulation Training; Students, Medical; Videotape Recording
PubMed: 31890870
DOI: 10.15766/mep_2374-8265.10835 -
Pediatrics International : Official... Jan 2022
Topics: Acidosis; Dynamins; GTP Phosphohydrolases; Humans; Mitochondrial Encephalomyopathies
PubMed: 35072965
DOI: 10.1111/ped.14879 -
Emergency Medicine Clinics of North... Aug 2005Metabolic acidosis is defined as an acidemia created by one of three mechanisms: increased production of acids, decreased excretion of acids, or loss of alkali. This... (Review)
Review
Metabolic acidosis is defined as an acidemia created by one of three mechanisms: increased production of acids, decreased excretion of acids, or loss of alkali. This article addresses the identification and correct diagnosis of metabolic acidosis by reviewing important historical factors, pathophysiological principles, clinical presentation,and laboratory findings accompanying common high and normal anion gap metabolic acidoses in emergency department patients.
Topics: Acid-Base Equilibrium; Acidosis; Adult; Diagnosis, Differential; Female; Humans; Male
PubMed: 15982545
DOI: 10.1016/j.emc.2005.03.007 -
Clinical Journal of the American... Apr 2012Nongap metabolic acidosis is a common form of both acute and chronic metabolic acidosis. Because derangements in renal acid-base regulation are a common cause of nongap... (Review)
Review
Nongap metabolic acidosis is a common form of both acute and chronic metabolic acidosis. Because derangements in renal acid-base regulation are a common cause of nongap metabolic acidosis, studies to evaluate renal acidification often serve as the mainstay of differential diagnosis. However, in many cases, information obtained from the history and physical examination, evaluation of the electrolyte pattern (to determine if a nongap acidosis alone or a combined nongap and high anion gap metabolic acidosis is present), and examination of the serum potassium concentration (to characterize the disorder as hyperkalemic or hypokalemic in nature) is sufficient to make a presumptive diagnosis without more sophisticated studies. If this information proves insufficient, indirect estimates or direct measurement of urinary NH(4)(+) concentration, measurement of urine pH, and assessment of urinary HCO(3)(-) excretion can help in establishing the diagnosis. This review summarizes current information concerning the pathophysiology of this electrolyte pattern and the value and limitations of all of the diagnostic studies available. It also provides a systematic and cost-effective approach to the differential diagnosis of nongap metabolic acidosis.
Topics: Acid-Base Equilibrium; Acidosis; Animals; Biomarkers; Diagnosis, Differential; Humans; Kidney; Models, Biological; Predictive Value of Tests; Prognosis; Severity of Illness Index
PubMed: 22403272
DOI: 10.2215/CJN.09450911