11 Introduction to Metabolic Acidosis

277

S. Faubel and J. Topf11 Metabolic Acidosis: The Overview

11

WARNING: It has been longer since freshman chemistry than you realize. We stronglyadvise reading Chapter 10,

Introduction toAcid-Base

before advancing beyond this point.

Metabolic Acidosis:11The Overview

278

The Fluid, Electrolyte and Acid-Base Companion

Metabolic acidosis is characterized by a low bicarbonate, a low pH and,after respiratory compensation, a low P

CO

2

.Metabolic acidosis occurs by one of two mechanisms:• loss of bicarbonate• addition of acid

Introduction



Metabolic acidosis is characterized by a fall in thearterial concentration of bicarbonate.

METABOLIC

ALKALOSISRESPIRATORY

ACIDOSISMETABOLIC

ACIDOSIS

This chapter is an introduction to the pathophysiology and differential diagnosis of the twotypes of metabolic acidosis.Additionally, the formulas used to uncover other acid-base dis-orders are reviewed.This chapter should be read prior to Chapters 12 and 13.

Metabolic acidosis is characterized by a _____ (low/high) pH and a _____(low/high) bicarbonate concentration. After compensation for metabolic acidosis, the P

CO

2

is _____ (low/high).Metabolic acidosis is due to either the ________ (loss/gain) of bicarbon-ate or the addition of ________.lowlowlowlossacid

pH

∝

HCO

3 –

CO

2

pH

∝

HCO

3 –

CO

2

pH

∝

HCO

3 –

CO

2

pH

∝

HCO

3 –

CO

2

279

S. Faubel and J. Topf11 Metabolic Acidosis: The Overview

Mechanism



Metabolic acidosis can be caused by the loss ofbicarbonate.

One type of metabolic acidosis is due to the loss of bicarbonate. By thismechanism, direct loss of bicarbonate lowers the plasma bicarbonate con-centration. The decrease in bicarbonate causes the concentrations of bothhydrogen and chloride to increase.

Increased hydrogen

(decreased pH). Hydrogen and bicarbonate are inequilibrium with water and carbon dioxide as shown in the bicarbonate bufferequation above. Loss of bicarbonate drives this equation toward the produc-tion of bicarbonate and hydrogen. The increase in bicarbonate production isnot sufficient to replace the lost bicarbonate and its concentration remainslow. However, the increase in hydrogen production does raise the hydrogenconcentration, decreasing pH.

Increased chloride

. Bicarbonate is one of the primary anions in thebody. If this anion decreases, another anion must increase in order to main-tain electroneutrality. When bicarbonate is lost, chloride increases, main-taining electroneutrality.

Both mechanisms of metabolic acidosis result in a decreased bicarbonateand a(n) __________ (decreased/increased) pH.If bicarbonate is lost, then the chloride concentration ___________(decreases/increases).aaadecreasedincreases

Loss of bicarbonateshifts the bicarbonatebuffer equation to-ward the productionof hydrogen ion.

HCO

3

H

+

HCO

3

H

+

C

HCO

3