Is your body too acidic? Let's learn about metabolic acidosis!

Have you ever felt tired, hungry, or dizzy? Or maybe your breathing has increased a bit, or your chest is pounding? These can sometimes be caused by small changes in the balance inside your body. Today we are going to talk about a condition that requires a little attention, but if you are aware of it, it can be helped to control. That is called metabolic acidosis . The name may sound a little scary, but let's talk about it simply.

What is Metabolic Acidosis? Simply put...

Simply put, metabolic acidosis is when the fluids in your body, especially your blood, become too acidic or acidic . Think of our bodies as delicate machines. Everything in them, especially the chemicals, needs to be in perfect balance. When that doesn't happen, problems start to arise.

Our bodies have a chemical called bicarbonate . This is the main base that controls, or neutralizes, the acidity of the body. So, there are two main ways that metabolic acidosis can occur.

1. Either the amount of acid in the body increases more than necessary and exceeds the amount of bicarbonate (this is called 'High Anion Gap Metabolic Acidosis' ).

2. Otherwise, too much bicarbonate is excreted from the body through the kidneys or in other ways (this is called 'Normal Anion Gap Metabolic Acidosis') .

However, the end result is that the body becomes more acidic. You may have heard doctors talk about something called the 'Anion Gap' . This is simply the difference between the positively and negatively charged particles (electrolytes) in our blood. This allows doctors to get an idea of ​​the acid-base balance.

Who is most likely to be affected by this situation? Should we all be careful?

Actually, anyone can develop a condition called metabolic acidosis. However, this risk is especially high for those whose kidneys are not functioning properly (Kidney Failure / Renal Failure) or those who have chronic kidney disease . This is because our kidneys play a major role in keeping the body balanced by removing the excess acid produced in our body through urine. So when the kidneys are weak, this function does not work properly.

What happens inside the body when this acidity increases? The story about our pH value

For all of our body's systems to function properly, our blood needs to be in a certain range called pH balance . This pH is a measure of how much acid and alkali there is in our blood. It is a scale from 0 to 14. 0 is very acidic, and 14 is very alkaline. The pH of a healthy person's blood is usually between 7.35 and 7.45.That's what it should be. This is a very delicate balance.

Our kidneys and lungs are the main organs that help maintain this balance. The kidneys excrete excess acids and bases in the urine. The lungs control the amount of carbon dioxide in the blood when we breathe. Carbon dioxide also affects the acid level in the body.

So, in metabolic acidosis, either the metabolic processes in the body produce too much acid, or the kidneys are unable to properly excrete this acid. Then the pH we mentioned drops below 7.35, meaning the blood becomes more acidic.

What are the symptoms of this? It's very important to be aware of these!

Surprisingly, sometimes people with metabolic acidosis may not show any specific symptoms at first . However, there are some common signs that can be seen as the condition progresses. It is important for you and your family to be aware of these:

• A sudden rapid heartbeat (tachycardia). It can feel like your chest is pounding, or like you're panicking.
• Feeling dizzy or lightheaded. Sometimes it can happen even when standing up.
• Feeling very tired, feeling lifeless and tired all the time. No matter how much sleep you get, you still feel tired.
• Anorexia, feeling disgusted even at the sight of food.
• Persistent headache.
• Breathing becomes faster, or takes longer, deeper breaths. This is actually the body trying to reduce acidity by exhaling more carbon dioxide (a type of acid).
• Nausea and vomiting.
• Feeling of weakness and general weakness.
• A sweet, fruity smell to the breath. This is especially a symptom of diabetic ketoacidosis.

Very important: If this condition becomes significantly severe, that is, if the acid level in the body increases significantly, serious complications such as kidney failure, damage to other organs, loss of consciousness, and even death can occur . Therefore, if you have one or more of these symptoms, it is wise to seek medical advice without delay.

Why does this happen? What are the main causes of metabolic acidosis?

There are four main categories of causes that can lead to metabolic acidosis. Let's take a look at what they are:

1. Diabetes-related acidosis / Diabetic Ketoacidosis (DKA):Many people have heard of this. It can develop in people with poorly controlled diabetes, especially those with Type 1 Diabetes. When the body's cells lack the insulin they need to produce energy, or when the insulin they do have doesn't work properly, the cells can't take in glucose from the blood. The body then starts burning fat for energy. As a byproduct of this process, a type of acid called 'ketone bodies' builds up in the body. This is a very dangerous condition that requires immediate treatment.

2. Hyperchloremic acidosis: This is caused by the body losing too much of the valuable mineral sodium bicarbonate. Imagine, you have severe diarrhea for several days , to the point where you lose water. At that time, a large amount of bicarbonate can be released from the intestines. This can also happen if you use certain laxatives ( laxatives ) excessively, without consulting a doctor.

3. Lactic acidosis: This condition occurs when our body has too much of a type of acid called lactic acid. Think about it, when we exercise too hard, or when our body cells don't get enough oxygen (e.g., a heart attack, a severe infection), lactic acid is produced as a byproduct of making energy. Normally, the body controls this. But sometimes, for example, in someone with liver failure , or when blood sugar suddenly drops (Hypoglycemia or Low blood sugar) , or if some people use alcohol excessively (Alcohol use disorder) , in some cancer conditions , or if we exercise too hard (Intense exercise) , the amount of lactic acid can increase and the body can't handle it.

4. Renal Tubular Acidosis (RTA): This occurs when the small tubes (tubules) in the kidneys are unable to excrete enough acid with the urine. Or, the bicarbonate is not reabsorbed properly. As a result, the acidity of the blood gradually increases.

The two most common causes are unmanageable diarrhea and kidney failure.

Is this a contagious disease? Will others get it from me?

No, not at all. Metabolic acidosis is not a contagious disease . You cannot spread it to someone else just because you have it. It is a problem with the internal chemical balance of the body.

How do doctors diagnose this?

When you go to see a doctor, he or she will first ask you about your symptoms, ask about your past medical conditions, and then examine you. He or she will then order several tests to confirm the condition and find the cause.

Sometimes you may be referred to a nephrologist , especially if a kidney problem is suspected.

What do you do with these tests?

Tests may vary depending on your symptoms and what your doctor thinks is the cause. The most common tests are:

• Blood tests: These are very important.
• Anion Gap Test: A small sample of blood is taken from a vein in your arm and the difference between the positive and negative charged chemicals called electrolytes is measured. If this gap is larger than normal, it can be a strong indication that you have metabolic acidosis.
• Arterial Blood Gas (ABG) test: This is a slightly different test. This involves taking a small amount of blood from an artery in your wrist, elbow, or groin (usually a little smaller than a vein). This measures the oxygen level, carbon dioxide level, and most importantly, the pH of your blood. A pH of less than 7.35 means your blood is too acidic or too basic.
• Other blood tests: Blood sugar levels, kidney function tests (e.g. Serum Creatinine, BUN), and electrolyte levels (Electrolytes like Sodium, Potassium, Chloride) may also be checked.

• Urine tests:

When you urinate into a special bottle, the pH is checked. This can tell you things like whether your urine is too acidic, too basic, or contains ketones.

How is this treated? (Treatment)

Once your doctor has determined the exact cause of your metabolic acidosis, he or she will give you a treatment plan that works for you. The treatment depends on the cause.

• The most important thing is to treat the cause . For example, in diabetic ketoacidosis, blood sugar is controlled by administering insulin and IV fluids.
• People with kidney disease can be given sodium bicarbonate in the form of tablets or sodium citrate in the form of a solution to reduce the acidity of the body.
• If a lot of fluid has been lost from the body (e.g. due to diarrhea), it is essential to give saline (IV fluids) through a vein.
• In some severe cases, sodium bicarbonate is given through a vein (IV Sodium Bicarbonate) to quickly balance the acidity of the blood.
• If a toxic substance has entered the body (e.g., from taking too much aspirin or ingesting a chemical such as methanol), special treatment (e.g., dialysis) may be required to remove the toxic substance from the blood.

Does food and drink have an effect on this? What should I eat and what should I eat less of?

Yes, absolutely. Some of the foods and drinks we eat increase the acidity of the body, while others increase the alkalinity and help reduce acidity. However, this is very important: Before making any major changes to your diet, you should definitely talk to your doctor or a dietitian. This advice is especially important if you have kidney disease.

Acid-forming foods:

• Meats (especially red meat, chicken, fish).
• Eggs.
• Cheese and other dairy products (some).
• Processed grains.
• Alcohol.

Alkaline-forming foods that increase the body's alkalinity, that is, help reduce acidity:

• Many types of fruit (especially citrus fruits).
• Nuts and nut butters.
• Legumes (e.g. lentils, chickpeas, green beans, soy).
• Many vegetables (especially green vegetables).
• Some people talk about alkaline water , but there are different opinions about the scientific basis for this, so it's best to ask a doctor.

What other medications are used for this?

Sometimes over-the-counter (OTC) medications such as Sodium Citrate or Sodium Bicarbonate can help balance the acidity in the body. However, do not use any of these medications without consulting your doctor, as they can cause other problems.

In some severe cases, when the heart is not working properly and the body is not getting enough oxygen, doctors may prescribe medications called inotropes . These make the heart beat more strongly. This helps the body get more oxygen and helps reduce the acidity of the blood. These medications are usually given through a vein (IV) in a hospital.

Is there anything we can do to reduce the development of metabolic acidosis?

While it's impossible to completely prevent this situation, there are a few things we can do to reduce the risk:

• Drinking enough water and other healthy fluids throughout the day.
• If you have diabetes, it's important to control your blood sugar levels as prescribed by your doctor. This includes medication, diet, and exercise.
• If you drink alcohol, limit the amount you drink or stop drinking altogether. A healthy limit is considered to be no more than two standard drinks per day for men and no more than one standard drink per day for women.
• Eating a balanced diet.

What will happen in the future with this situation? Is it something to be afraid of? (Outlook)

If you have metabolic acidosis, the future depends on the severity of the condition, what caused it, and how quickly and properly you receive treatment.

• In most cases, this condition can be reversed with proper diagnosis and treatment.
• In mild cases , symptoms may be temporary and may not require special treatment if the cause resolves on its own.
• But, as I said before, in severe cases, if left untreated, it can lead to kidney or other organ failure, and even death. That's why this is not something to take lightly.

How can I take care of myself? What are some things I can do on my own? (Self-care)

Your doctor will create a treatment plan that is right for you. It will include medications and lifestyle changes. Following these steps will help speed your recovery and prevent the condition from recurring:

• Check your blood sugar levels regularly (if you have diabetes). Do home blood glucose monitoring as directed by your doctor.
• Take the medicine prescribed by your doctor exactly, at the right time, and in the right dosage. Don't miss a single dose.
• If your doctor or nutritionist advises you, try to eat foods that are less acidic and more alkaline.
• Limit or stop drinking alcohol completely.
• Keep your doctor appointments on time. That way, you can see how you're doing and make any necessary changes.

When should I see a doctor? Is it an emergency?

If you have symptoms of metabolic acidosis (such as the fatigue we discussed earlier, changes in breathing, nausea), or if you have severe symptoms of another condition that could be causing this condition (e.g., uncontrolled diabetes, severe diarrhea, symptoms of kidney disease), seek medical attention immediately. Don't delay.

What is the difference between Metabolic Acidosis and Respiratory Acidosis?

Although both of these are conditions in which the body's acidity increases, the way they occur and the organ systems that are primarily affected are different.

Metabolic acidosis is a condition that mainly affects the body's metabolism and urinary system, especially the kidneys . It occurs when either too much acid is produced in the body, or the kidneys are unable to properly filter acid from the blood, or the body loses bicarbonate.

Respiratory acidosis is a condition that primarily affects the respiratory system, or lungs . This is when the lungs are unable to remove carbon dioxide (CO2) from the blood quickly enough. CO2 combines with water to form an acid. When conditions such as asthma become severe, lung disease (such as COPD), brain damage that causes difficulty breathing, or excessive use of certain drugs or sleeping pills can affect lung function, causing CO2 to accumulate and increase acidity.

Simply put, metabolic is the problem with the chemical processes inside the body and the kidneys. Respiratory is the problem with the breathing process and the lungs.

Finally, the most important things you need to remember (Take-Home Message)

Metabolic acidosis is a condition that you should really be concerned about, because it affects the body's basic balance. Sometimes you can try to ignore the symptoms and pretend, "It'll be okay." But remember, it's your body talking to you and saying, "Something is seriously wrong inside, help me."

You should be very careful about these symptoms, especially if you have long-standing illnesses like kidney problems or diabetes.

But don't worry. You are not alone. There are skilled doctors, nurses, and other healthcare professionals who can help you and get you out of this situation. With an accurate diagnosis and prompt, proper treatment, this condition can be controlled to a great extent and reversed. Therefore, if you have any doubts about this, do not be shy or delay in seeing a doctor, ask your questions, and get the necessary advice and treatment. Because, your health is the most valuable thing in this world!

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