What is Metabolic Acidosis?

If the metabolism of the organism is out of balance, in untreated cases this can lead to coma and general intoxication, which can even be fatal. Metabolic acidosis is therefore a complication that should be treated promptly.

What is Metabolic Acidosis?

Acidosis is a well-known condition in which the pH shifts in such a way that there is an increase in acidic components. See AbbreviationFinder for abbreviations related to Metabolic Acidosis.

For this reason, over-acidification is achieved within the metabolism, which leads to damage to individual organs. When blood pH is measured during metabolic acidosis, results below 7.36 due to an increase in hydrogen ion levels are not uncommon.

This parameter is extremely worrying and indicates an increase in the percentage of acid in the metabolism. This has to do with a derailment of the so-called acid-base balance.


Several criteria can be considered as causal triggers for metabolic acidosis. The balance between acids and bases in the body’s metabolism can shift if people with diabetes mellitus have too high a sugar concentration as part of hyperglycemia or if fewer hydrogen ions can be excreted due to a loss of kidney function.

Other causes of metabolic acidosis are urea poisoning, persistent starvation, and persistent severe diarrhea. Conditions such as Addison’s disease, extensive burns, methanol (alcohol) poisoning, or fistulas located in the stomach can also trigger metabolic acidosis.

In all causes of metabolic acidosis, there is either an increased accumulation of hydrogen ions, an additional excretion of bicarbonates, or a “congestion” of hydrogen ions.

Typical Symptoms & Signs

  • shortness of breath
  • hyperventilation
  • Frequent urination
  • bad breath
  • headache
  • Low resilience
  • cardiac arrhythmias
  • Low blood pressure (hypotension)

Diagnosis & History

Metabolic acidosis triggers an increased respiratory rate (hyperventilation) to rebalance metabolism by increasing the exhalation of hydrocarbon ions. This special breathing is known in medicine as Kussmaul breathing.

It usually occurs when there is a metabolic imbalance caused by diabetes mellitus. Another side effect of metabolic acidosis is the fruity smell in the mouth and urine of those affected. Clinically, metabolic acidosis also comes to the fore through reduced blood pressure . Cardiac rhythm disturbances are also noteworthy in metabolic acidosis. A deep loss of consciousness can also occur.

The diagnosis of metabolic acidosis refers not only to the clinical abnormalities and the deficits in the general condition, but also to the values ​​of the laboratory measurements. In the case of metabolic acidosis, these include parameters such as creatinine and urea nitrogen in the serum, bicarbonate in the serum and urine, and primarily the pH value of the urine. A further diagnosis can be carried out in the case of metabolic acidosis using the carbon dioxide partial pressure.


In the worst case, this disease leads to the death of the patient. It must therefore be treated by a doctor to prevent consequential damage or other complications. As a rule, those affected suffer from severe shortness of breath and also from hyperventilation. The shortness of breath can also lead to a loss of consciousness, which can lead to a fall and possible injuries.

The internal organs may also be undersupplied and damaged due to the shortness of breath. Furthermore, there is a very bad breath, which can be very unpleasant for the person concerned and the outsiders. This can lead to social tensions. Furthermore, the patient’s resilience decreases significantly due to the disease and severe headaches occur.

The heart is also affected by the disease, resulting in cardiac arrhythmia and low blood pressure in the patient. The patient’s quality of life is significantly reduced. Treatment usually takes place with the help of medication. In addition, dialysis may be necessary for the patient to prevent death. This disease may reduce the life expectancy of those affected.

When should you go to the doctor?

A visit to the doctor is advisable as soon as you feel ill or have reduced performance. If you have bad breath, headaches or if your physical and mental resilience is declining, you need to see a doctor. Fatigue, fatigue and rapid fatigue are signs of an existing discrepancy.

If everyday obligations can no longer be met, the person concerned needs medical help. Disorders of the heart rhythm, severe heart palpitations or an increased pulse rate must be examined and treated. Suddenly low blood pressure is a warning signal from the body. A doctor’s visit is necessary so that a diagnosis can be made and treatment can be started. If breathing problems occur, a doctor should also be consulted.

Hyperventilation, a lack of oxygen, or anxiety due to shortness of breath should be presented to a doctor. If the skin turns blue or your fingers and feet are cold, there is an insufficient supply of oxygen to the organism. A medical check-up is therefore necessary as soon as there is a strong sensation of cold or blue lips. In the event of acute shortness of breath, an emergency service must be alerted. Until it arrives, first aid measures must be taken to ensure an adequate supply of oxygen. Since metabolic acidosis can, in severe cases, lead to the premature death of those affected, a doctor’s visit should be made as soon as the first irregularities appear.

Treatment & Therapy

Metabolic acidosis is corrected with emergency measures and other treatments. Acute signs of disease associated with metabolic acidosis are relieved by supplemental ventilation and administration of bicarbonate.

This results in an increased emission of carbon dioxide through the lungs. If patients with diabetes develop metabolic acidosis, the insulin level must be increased rapidly to counteract diabetic acidosis. Bicarbonates for oral administration as tablets promote the balancing of the acid-base balance.

If there is a suspicion that kidney function failure is the original cause of metabolic acidosis, those affected can undergo blood purification and detoxification through dialysis (blood washing). A copious intake of appropriate fluids also reduces metabolic acidosis when unconsciousness is not present.

Outlook & Forecast

Without medical care, the prognosis of metabolic acidosis is extremely poor. It can lead to numerous complications, a comatose state and the premature death of the person concerned. It is therefore urgently advisable to consult a doctor as soon as the first health problems arise. This is the only way to ensure the survival of those affected.

Intensive medical care is required to improve health. The prospect of alleviating the symptoms therefore increases if adequate medical care is initiated at an early stage. Otherwise, a continuous increase in very unpleasant health problems can be expected. Over a longer period of time, quality of life deteriorates, resilience decreases, and cardiac arrhythmia occurs. If there are other diseases of the cardiac rhythm system or organic disorders, the prognosis is additionally worse. In spite of all efforts and early medical care, these patients in particular often suffer from long-term health impairments. In these cases, subsequent disturbances can occur,

The patient is dependent on long-term drug therapy. They also have to undergo regular check-ups. Otherwise, the symptoms can recur at any time and the disease can return.


In order to avoid metabolic acidosis through appropriate prophylaxis, the risk groups with a corresponding pre-existing condition should drink a sufficient amount of liquid every day and be physically active.

The amount of liquid should be at least 2500 ml per day. Metabolic acidosis can also be prevented in diabetes mellitus by correct insulin adjustment. People with bronchial asthma and chronic kidney disease should implement their diet and lifestyle based on medical advice. In this context, excessive intake of alcoholic beverages and smoking are not recommended as prevention against metabolic acidosis.


Since a metabolic disorder can have a wide variety of underlying causes, the aftercare must also be very individually designed for the patient. There is therefore no simple direction in follow-up care for metabolic acidosis. It often does not represent an independent clinical picture, but is the symptom or the consequence of another systemic disease.

Depending on the severity of the metabolic disorder, the specialist must adapt the aftercare to the patient. In some cases, the causative disease cannot be cured, which means that follow-up care must also be permanent with regular check-ups and doctor’s appointments. As a rule, the symptoms can be largely suppressed, this can be done by long-term administration of appropriate medication.

In general, aftercare can aim to alleviate the accompanying symptoms. Those affected should therefore ensure that they drink enough fluids in order to avoid renewed hyperacidity.

You can do that yourself

A serious derailment of the so-called acid-base balance is a very serious disorder and potentially life-threatening. Risk groups should therefore know the typical symptoms and consult a doctor as soon as possible. The risk groups include, in particular, people suffering from diabetes mellitus, patients with severe diarrhea and people who are chronically undernourished and alcoholics.

In addition to a number of non-specific symptoms, metabolic acidosis causes an idiosyncratic bad breath, often described as bitter and fruity. The urine also often takes on a corresponding odor note. As soon as these symptoms appear, a doctor must be consulted immediately. Patients can also help themselves in this situation by increasing their fluid intakeraise. In the case of acute hyperacidity, the person affected should drink at least one liter of liquid as soon as possible. Alkaline healing waters are particularly recommended, otherwise normal mineral water or unsweetened tea can also be drunk. In the case of incorrectly controlled diabetics, the insulin level often has to be increased quickly. In addition, the administration of bicarbonates helps to restore the acid-base balance. Bicarbonates can be found in almost every household in the form of soda, Kaiser baking soda, Bullrich salt or baking powder.

Adequate intake of fluids, ideally at least 2.5 liters per day, in connection with sufficient exercise, can also prevent acidosis in patients at risk.