What should be the focus of the history in patients with suspected metabolic acidosis?

Updated: Oct 10, 2018
  • Author: Christie P Thomas, MBBS, FRCP, FASN, FAHA; Chief Editor: Vecihi Batuman, MD, FASN  more...
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The clinical history in metabolic acidosis is helpful in establishing the etiology when symptoms relate to the underlying disorder. The age of onset and a family history of acidosis may point to inherited disorders, which usually start during childhood. Important points in the history include the following:

  • Diarrhea - GI losses of HCO3-

  • History of diabetes mellitus, alcoholism, or prolonged starvation - Accumulation of ketoacids

  • Polyuria, increased thirst, epigastric pain, vomiting -Diabetic ketoacidosis (DKA)

  • Nocturia, polyuria, pruritus, and anorexia - Renal failure [8]

  • Ingestion of drugs or toxins - Salicylates, acetazolamide, cyclosporine, ethylene glycol, methanol, metformin, topiramate

  • Visual symptoms, including dimming, photophobia, scotomata - Methanol ingestion

  • Renal stones - RTA or chronic diarrhea

  • Tinnitus, blurred vision, and vertigo - Salicylate overdose

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