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

Updated: Dec 08, 2020
  • Author: Christie P Thomas, MBBS, FRCP, FASN, FAHA; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Symptoms of metabolic acidosis are not specific. The respiratory center in the brainstem is stimulated, and hyperventilation develops in an effort to compensate for the acidosis. As a result, patients may report varying degrees of dyspnea. Patients may also report chest pain, palpitations, headache, confusion, generalized weakness, and bone pain. Patients, especially children, also may present with nausea, vomiting, and decreased appetite.

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 [12]

  • 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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