Metabolic Acidosis

Metabolic acidosis happens when the blood becomes too acidic. It can happen in infants, children, and adults for many different reasons. Metabolic acidosis may range from mild to severe, or even life-threatening.


Metabolic acidosis happens as a result of one of the following:

  • The body produces too much acid.

  • You consume a toxic substance that increases the acid content in the blood.

  • The body loses an important element, such as bicarbonate, which helps to balance acid.

  • The kidneys do not remove enough acid from the body.

There are many causes. Metabolic acidosis can be brought on by chronic or life-threatening conditions, such as:

  • Diabetes.

  • Kidney disease or failure.

  • Liver failure.

  • Seizures.

  • Diarrhea.

  • Gastrointestinal conditions (or gastrointestinal surgery).

  • Severe dehydration.

  • Cancer.

  • Shock.

  • Severe infections that affect the whole body (systemic).

  • Anemia.

  • Heart failure.

  • Exposure or ingestion of poisons or toxic substances, such as:

  • Carbon monoxide, cyanide, ethylene glycol (antifreeze), or methanol.

  • Excessive use of supplements, including iron and performance-enhancing drinks.

  • Medicine, such as:

  • Aspirin.

  • Acetazolamide.

  • Lifestyle factors, such as:

  • Excess alcohol.

  • Prolonged intense exercise without proper rest and rehydration.

  • Malnutrition or fasting.


Mild acidosis may not cause symptoms. More severe acidosis may cause:

  • Rapid breathing.

  • Feeling sick to your stomach (nauseous).

  • Throwing up (vomiting).

  • Headache.

  • Confusion.

  • Fatigue.

  • Weakness.

  • Altered level of consciousness.


Diagnosis is made by:

  • Physical exam and patient history.

  • Blood tests. Sometimes, an arterial blood gas test (ABG) is needed. The blood is taken from an artery in the wrist. This test can measure the specific pH of the blood.

  • Urine tests.


Severe forms of metabolic acidosis require hospital treatment and inpatient care. Treatment depends on the cause and severity of the metabolic acidosis. Treatment is aimed at restoring balance of acid (normal pH) in the blood and treating the underlying cause.

Treatment may include fluid support, administration of sodium bicarbonate to neutralize the acids, or management of kidney disease, diabetes, infections, or other underlying conditions.


Severe cases of metabolic acidosis require treatment since it can lead to shock or even death. There is a very good chance of correcting metabolic acidosis when the problem that caused it is successfully treated. The earlier the acidosis and cause are found, the more likely the treatment will be successful.


To prevent metabolic acidosis in the future, follow these guidelines:

  • Manage chronic conditions. Take your medicines as directed. Failure to take certain medicines, or taking too much of them, can predispose you to acidosis.

  • Avoid exposure to poisons and toxins.

  • Limit alcohol intake.

  • Drink enough water and fluids to keep your urine clear or pale yellow.

  • Understand your medicines and supplements, and their possible side effects.


  • Continue taking your medicines as directed.

  • Take any new medicines prescribed by your caregiver. You may be given antibiotic medicine if you have an infection.

  • Maintain good hydration and nutrition.

  • If you get dialysis, do not miss any appointments.

  • Get plenty of rest.

  • See your caregiver for close follow-up. You may need more blood tests.


  • You have shortness of breath, chest pain, or a fast heartbeat (palpitations).

  • You develop worsening nausea, vomiting, or uncontrolled diarrhea.

  • You develop worsening body aches, fatigue, or lethargy.

  • You experience worsening levels of consciousness or you faint.

  • You develop worsening signs of dehydration, you cannot eat, or you are producing less urine.

  • You have uncontrolled pain in your joints and limbs.

  • You have uncontrolled, severe abdominal pain.