Metabolic Acidosis (Beware especially if Diabetic type-1/Ketosis/Lactic acidosis/Respiratory Acidosis)

Cause

• Infection examples (especially in diabetics)- [caused by increased insulin resistance owing to the increase in counter-regulatory hormones (cortisol and glucagon) during infection​]:
  • Pneumonia
  • Urinary tract infection

Metabolic acidosis

• Diabetes especially Diabetes type-1  however there has been increase in incidence with Diabetes type -2 (‘ketosis prone diabetes’, ‘flatbush diabetes’ or ‘type 1.5’) that is not controlled –  Ketoacidosis (the body burns fat instead of carbohydrates as fuel) because not have enough insulin (with increased production of counter-regulatory hormones, catecholamines, cortisol, glucagon and growth hormones)  and that makes ketones. Lots of ketones in your blood turn it acidic). This causes a viscous cycle of:
  • Hyperglycaemia (high sugar levels) with ketosis – Hyperglycaemia is driven by increases in hepatic (liver) gluconeogenesis and glycogenolysis (increased glucose production), paired with a decrease in uptake of glucose into the body tissues and organs.
  • The hormone imbalance and free fatty acids also drive resistance to any remaining insulin.
  • The rise in blood glucose levels leads to osmotic diuresis (can’t stop going to the toilet to urinate)  causing significant dehydration and loss of electrolyte.
  • Lactic acidosis is more common in people with diabetes and in those who are hypovolaemic (loss of both salt and water or a decrease in blood volume, it is not the same as dehydration)

• • Other conditions causing ketoacidosis/lactic acidosis/metabolic acidosis:
    • Cytochrome C Oxidase deficiency
    • Mitochondrial Myopathy and/or Encephalomyopathy
    • MELAS syndrome
    • Primary distal renal tubular acidosis
    • Pyruvate carboxylase deficiency
    • Pyruvate dehydrogenase complex deficiency
    • TANGO2 deficiency

• Eating a high fat and low carbohydrate diet
• Low blood sugar levels i.e. Addison disease
• High levels of alcohol consumption (People who drink a lot of alcohol for a long time and don’t eat enough also build up ketones)
• If one does not eat food i.e. fasting, starvation, anorexia
• Eating high levels of protein based foods containing sulpur i.e. meats, eggs, and dairy products
• Eating high levels of salty food causing difficulty for acid to be removed by the kidneys.
• Glutathione synthetase deficiency
• Low fruit and vegetable diet
• Seizures
• Heart attack (the body make lactic acid because  they don’t have a lot of oxygen to use causing acid to build up)
• Heart failure (the body make lactic acid because  they don’t have a lot of oxygen to use causing acid to build up)
• Low blood pressure (the body make lactic acid because  they don’t have a lot of oxygen to use causing acid to build up)
• Liver disease
• Severe Anaemia
• Kidney disease – (this causes dehydration and one loses bicarbonate from their blood into their urine – bicarbonate is required to neutralise the acid)
  • Osteopetrosis with renal tubular acidosis (carbonic anhydrase II deficiency or Guibaud-Vainsel syndrome)
• Genetic disease that affect metabolism and the mitochondria (energy source of the cells)
• Multiple sulfatase deficiency
• Renal tubular acidosis- (kidney disease where one builds up acid in their kidney as it does not remove from the blood into ones urine)
  • Medullary Sponge Kidney
• Hyperchloremic acidosis because the kidneys reabsorb chloride (Cl⁻) instead of reabsorbing carbonate
• Kidney failure – (increase of sulfates, phosphates, urate, and hippurate)
• Exercise intensely (the body make lactic acid because  they don’t have a lot of oxygen to use causing acid to build up and one lose water via sweating causing dehydration)
• Muscle disease/disorders where body produces too much lactic acid
• Chronic (long term) diarrhoea (this causes dehydration and one loses bicarbonate from their blood into their urine – bicarbonate is required to neutralise the acid)
• Dehydration – (this causes dehydration and one loses bicarbonate from their blood into their urine – bicarbonate is required to neutralise the acid)
• Hypothermia (Medical emergency)
• Malignant hyperthermia
• Respiratory acidosis (where body has too much carbon dioxide and this causes acid to increase in the blood due to respiratory condition/disease)
• Carbon monoxide or other chemicals (where body has too much carbon dioxide and this causes acid to increase in the blood)
• Methylmalonic acidemia
• Chemicals i.e. strong alcohols i.e. methanol, anti-freeze, poisons
• Valinemia
• Very long-chain acyl-CoA dehydrogenase deficiency

Syndromes

• Pallister-Hall syndrome
• Sjogren’s syndrome
• Tumor lysis syndrome

Medication

• Aspirin
• Salicylates
• Non-steroidal anti-inflammatory drugs (NSAIDS)
• Bisacodyl (laxative)
• Diazepam
• Penicillins
• Trimethoprim
• Antiretrovirals
• Oxaliplatin or cisplatin
• Isoniazid
• Ethylene glycol (found in antifreeze) or methanol
• Metformin (Diabetes and polycystic ovary medication)- especially if one drinks high levels of alcohol– Both can cause a build up of lactic acid
• SGLT2 inhibitors (diabetic medication)  alone and in combinations (discontinue immediately)
• Spironolactone
• Laxatives that cause diarrhoea  – (this causes dehydration and one loses bicarbonate from their blood into their urine – bicarbonate is required to neutralise the acid)
• Carbonic anhydrase inhibitors
• Hydrochloride salts of amino acids
• Toluene
• Amphotericin
• Beta blockers
• Cholesterol ‘statin’ medication
• Not enough insulin given or poor insulin therapy
• Poisons

Illicit drugs

• Illicit drugs (People take illicit for a long time and don’t eat enough, also build up ketones)
• Cocaine overdose
• Heroin overdose

Respiratory acidosis

• Smokers
• Kidney failure
• Respiratory disease
• Long term respiratory disease i.e. chronic obstructive pulmonary disease
• Muscle disorders that affect breathing
• Stroke

Medication

• Opioids

Vitamins, herbals and minerals

• Aconite toxicity