What is Metabolic Acidosis? A Detailed Guide

Parul Dube

November 25, 2022

A healthy kidney can carry out many processes. One of these processes is to keep the body’s acid level balanced. The kidneys can do this by removing acid from the body through urine. Metabolic acidosis is a condition that occurs when the body fluids contain excessive amounts of acid. It happens when your kidneys and lungs cannot balance your body’s pH level. The body attempts to address the symptoms caused by the acidic state by regulating processes in the lungs, kidneys, and cells. There are many reasons why the body’s chemical balance can become more acidic. It implies the presence of either excessive acid or insufficient base. Metabolic acidosis is an underlying disorder that needs to get corrected to minimise morbidity and mortality. 

Metabolic Acidosis: An Overview

It is an acid-base imbalance caused by excessive absorption of acid or excessive bicarbonate excretion. Acute metabolic acidosis is another name for this condition. Acidosis can affect infants, kids, and adults of any age.

Blood should have a pH of about 7.4. According to a study, metabolic acidosis results from a pH less than the normal range of 7.35 to 7.45. A pH of 7.45 or above is indicative of alkalosis. Due to renal disease or kidney failure, the body may experience an acid accumulation or mild pH imbalance. Even though these numerical variances may appear minimal, they can be somewhat severe.It can cause a variety of health problems and is possibly life-threatening. You can treat it, but the treatment options vary depending on the underlying cause.

The underlying condition that is triggering metabolic acidosis is the primary source of the majority of symptoms. The following are some common signs of metabolic acidosis:

  • Long and deep breaths
  • Fast heartbeat
  • Confusion
  • Fatigue
  • Headache
  • Sleepiness or feeling tired
  • Lack of appetite
  • Jaundice
  • Vomiting 

Severe metabolic acidosis may cause death or shock. If you experience any of these, you must contact your doctor immediately.

Causes of Metabolic Acidosis

It occurs when the body produces too much acid or eliminates too much base. Inadequate acid excretion by the kidney might also cause it. The kidneys, not the lungs, are where metabolic acidosis begins. Based on causes, there are four primary kinds of metabolic acidosis:

Diabetic Acidosis or Diabetic Ketoacidosis (DKA), or Ketoacidosis

Diabetic acidosis is the outcome of the buildup of the acidic molecules known as ketone bodies brought on by uncontrolled diabetes (usually type 1 diabetes). When a diabetic patient doesn’t receive enough insulin and starts to get dehydrated, the body begins to burn fat for energy instead of carbohydrates, which results in the buildup of ketones. Since these ketones are naturally acidic, they cause your blood to become acidic. 

Hyperchloremic Acidosis

It occurs when your body excretes too much sodium bicarbonate, which is necessary to balance the acids in the blood. This kind of acidosis may also result from both vomiting and diarrhoea.

Renal Tubular Acidosis

Renal tubular acidosis can result from kidney disease, kidney failure, immune system abnormalities, and hereditary conditions that can harm the kidneys and cause them to leak too much acid into the blood. It happens when the kidneys cannot eliminate acids in the urine. 

Lactic Acidosis

It happens when the body creates too much or not enough lactic acid. Muscle cells are the principal producers of lactic acid. If you engage in prolonged vigorous exercise without adequate oxygen, your body will produce more lactic acid. Likewise, your body might produce more acids if you consume too many animal products. 

Other factors that can cause metabolic acidosis include:

  • A high-fat but a low-carb diet
  • Overweight
  • Dehydration
  • Poisoning from methanol or aspirin
  • Poisoning by carbon monoxide
  • Cancer


If left untreated, metabolic acidosis can develop into the following health issues:


Your body may lose bone strength as a result of metabolic acidosis. As a result, it can increase your risk of breaking vital bones like your hips or backbone.

Kidney Disease

Studies show metabolic acidosis can trigger or worsen kidney disease. However, it’s unclear how precisely this takes place. 

Muscle Loss

Your body needs albumin, a protein crucial for healthy muscle growth and maintenance. Metabolic acidosis, which lowers the body’s albumin production, causes muscle loss, also referred to as “muscle wasting.”

The HealthifyMe Note

Acid accumulation in the blood can lead to serious health complications if left untreated. Metabolic acidosis affects the kidneys, heart, digestion, and metabolism. Some people fully recover from metabolic acidosis, but others might not. How quickly you can address the primary cause of your metabolic acidosis significantly impacts how well you recover.

Test and Diagnosis

With these tests, your doctor can identify acidosis and determine the proper treatment. 

Anion Gap

The anion gap test helps to determine the chemical balance in your blood. It compares how much sodium, chloride, and bicarbonate—three positively and negatively charged ions—are present in the body. If there is a concerning difference between the oppositely charged electrolytes, your doctor will know something is wrong.

Arterial Blood Gases

This test assesses your blood’s pH, carbon dioxide, and oxygen levels. In addition, it helps identify various types of acidosis.

Urine Tests

You’ll need to give a urine sample if metabolic acidosis is suspected. Doctors will check the pH to see if your body eliminates acids and bases correctly. It can reveal ketoacidosis, renal issues, alcohol, aspirin, and antifreeze toxicity. More testing could be required to identify the source of your acidosis.


The type of treatment depends on the underlying cause of metabolic acidosis. There is a range of causes of acidosis that will temporarily go away without medical attention. 


Bicarbonate, a kind of carbon dioxide, is a necessary component of everyone’s blood. Blood bicarbonate levels below normal (less than 22 mmol/l) indicate metabolic acidosis. Due to its alkali nature, it can neutralise the acid. It keeps the blood’s acidity under control. However, unless your doctor advises, you shouldn’t take medications containing sodium citrate or sodium bicarbonate.

Dietary Change

Fruits and vegetables are alkalising, whereas meat, eggs, cheese, and cereals cause the body to produce acid. As a result, increasing your consumption of fruits and vegetables may help to lower your body’s acid production. Based on your stage of renal disease, your nutritionist can advise you on how to safely increase the appropriate types and quantities of fruits and vegetables in your diet.


Metabolic acidosis arises from the buildup of acid in your blood, causing a decrease in bicarbonate ions. The common adverse effects of untreated chronic metabolic acidosis include muscle degradation and abnormal bone metabolism. Therefore, follow the recommended dietary advice and take all medications as directed. In addition, you can check your acid-base levels through routine blood tests and examinations.

About the Author

Parul holds a Masters of Medical Science in Public Health Nutrition from the University of Glasgow, Scotland, and has worked across the globe from the U.K to New Zealand (NZ) gaining her License with the Health Professionals Council (HPC, UK) and the NZ Nutrition Council. From being a Gold medalist in Clinical Nutrition to being awarded an internship with World Health Organisation (WHO, Cairo, Egypt) and Contracts with CDC Parul has had a wide spectrum of work experiences. She is very passionate about Nutrition and Fitness and holds strong to her guiding mantras ‘ Move more’ and ‘Eat Food that your grandmother can recognize’!

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