Your body works around the clock to keep everything in balance, including the acid level in your blood. When this balance is upset and acid levels become too high, it can cause a condition called metabolic acidosis.
Metabolic acidosis is not a disease on its own. Instead, it is a sign that something else is wrong, like diabetes, kidney problems or other health issues. The symptoms can be mild or serious, depending on the cause.
Knowing the symptoms, causes and when to seek care can help you know when it’s time to get medical help.
What is metabolic acidosis?
Your body functions best when acid and base levels are balanced. Metabolic acidosis occurs when there is too much acid in the body or not enough bicarbonate, a substance that helps neutralize acid.
Although not a disease on its own, metabolic acidosis is a sign that another health issue is making it hard for the body to keep the right balance.
What happens in the body when you have metabolic acidosis?
Your blood needs to stay within a very narrow range for your organs to work properly. The kidneys and lungs help keep this balance.
The kidneys help remove extra acid by producing urine and keep bicarbonate levels steady. The lungs help control carbon dioxide, which also affects the acidity of the blood.
If the body produces too much acid, loses too much bicarbonate or the kidneys can't remove enough acid, metabolic acidosis can occur. When acid levels get too high, the body tries to fix it. One way it does this is by blowing out carbon dioxide with quick breathing.
Is metabolic acidosis dangerous?
Some people develop a mild or long-lasting metabolic acidosis, often slowly over time, especially if they have chronic kidney disease. Others can develop severe metabolic acidosis quickly, which can be a medical emergency.
In serious cases, high acid levels in the blood can disrupt how the heart, brain, lungs and other organs work. If not treated, severe metabolic acidosis can cause shock, organ failure or death.
What causes metabolic acidosis?
Metabolic acidosis can happen for different reasons.
Diabetes and diabetic ketoacidosis (DKA)
Diabetic ketoacidosis (DKA) is a serious complication of diabetes, mostly affecting people with Type 1. It happens when the body doesn’t have enough insulin. Without insulin, the body starts breaking down fat for energy, which produces substances called ketones. If too many ketones build up quickly, they can cause a dangerous acid imbalance in the body.
DKA is a medical emergency that needs quick treatment. If you have diabetes and feel very sick (especially if you have nausea, vomiting, or extreme thirst), you should go to the nearest emergency room or call 911.
Kidney disease (renal tubular acidosis)
Healthy kidneys help keep the body's acid and base balance by removing acid and saving bicarbonate. When the kidneys don’t work properly, they may not be able to maintain this balance. Chronic kidney disease is a common cause of ongoing metabolic acidosis.
Severe infections and sepsis
Serious infections can cause sepsis, a dangerous condition that affects how the body responds to infection. Sepsis can reduce the amount of oxygen reaching tissues, causing cells to produce energy differently. This can lead to a buildup of lactic acid and cause lactic acidosis, a type of metabolic acidosis.
Dehydration
Severe dehydration can disrupt blood flow, impair kidney function and make it harder for your body to maintain normal acid levels. Dehydration often happens alongside other illnesses but it can also contribute to metabolic acidosis, especially if you have vomiting, diarrhea or an infection.
Severe diarrhea
While many people believe that only excess acid causes metabolic acidosis, losing too much bicarbonate can also cause metabolic acidosis. Severe or long-lasting diarrhea can lead to a significant loss of bicarbonate through your stool (poop). Without enough bicarbonate to help balance acid levels, metabolic acidosis can develop.
Alcohol use or starvation
Sometimes, the body makes ketones even if someone doesn’t have diabetes. Drinking a lot of alcohol, fasting for a long time or starving can cause ketones to form and lead to metabolic acidosis.
Certain medications, overdoses or poisoning
Certain medications and toxic substances can disrupt the body's acid-base balance, which is important for keeping your body working properly.
Examples include:
- Overdosing on aspirin
- Poisoning from methanol (a type of alcohol)
- Poisoning from ethylene glycol (found in antifreeze)
- Toxic effects from some medicines
These situations need immediate medical help. If you or someone you know has taken a large amount of any of these substances, call Poison Control at 1-800-222-1222 or dial 911 right away.
What are the symptoms of metabolic acidosis?
Not everyone shows the same symptoms. Some people with mild metabolic acidosis might have very few or no symptoms. However, certain warning signs can include the following:
- Rapid breathing
- Unusual tiredness or weakness
- Nausea or vomiting
- Loss of appetite
- Headache
- Feeling generally unwell, a fast heartbeat (tachycardia)
- Shortness of breath
- Deep breathing
- Confusion
- Difficulty concentrating
- Feeling very sleepy or lethargic
- Breath that smells fruity or sweet
Why does metabolic acidosis cause rapid breathing?
When acid levels in the body increase, the lungs try to help by removing more carbon dioxide. The lungs help balance the blood's pH by blowing out carbon dioxide, which usually occurs through rapid breathing.
This faster, deeper breathing is the body's way of trying to fix the excess acid. Health care providers often consider rapid breathing an important sign of metabolic acidosis.
When should you seek emergency care?
Some symptoms might indicate a serious problem like severe metabolic acidosis or another dangerous condition. Call 911 or go to the ER right away if you experience:
- Very fast or deep breathing
- Severe shortness of breath
- Confusion or trouble staying awake
- Fainting
- Extreme weakness
- Chest pain
- Signs of shock, such as cold, clammy skin or very low blood pressure
- Symptoms of diabetic ketoacidosis, like excessive thirst, frequent urination, vomiting and confusion
- Suspected poisoning or overdose
These symptoms could be signs of a medical emergency that needs quick evaluation and treatment.
When should you schedule a medical appointment?
Contact your health care provider if you experience:
- Ongoing fatigue
- Nausea or vomiting
- Frequent diarrhea
- Symptoms of poorly controlled diabetes
- Worsening signs of chronic kidney disease
- Concerns about dehydration
- Abnormal blood tests showing low bicarbonate levels
How is metabolic acidosis diagnosed?
You can’t rely only on symptoms to diagnose metabolic acidosis. Many symptoms are similar to those of other illnesses and some people show few symptoms even if they have a serious acid-base problem. Usually, lab tests are needed to find out the cause.
Your provider may order:
- A basic or comprehensive metabolic panel
- Blood gas testing
- Kidney function tests
- Blood glucose testing
- Ketone testing
- Lactate testing
- Urine tests
How is metabolic acidosis treated?
Treatment varies depending on the cause of the problem.
Diabetic ketoacidosis (DKA)
For DKA, treatment options include:
- Insulin
- Intravenous (IV) fluids
- Electrolyte replacement
- Hospital monitoring
- Managing dehydration or diarrhea
Kidney disease
For chronic kidney disease, treatment may focus on:
- Managing kidney health
- Monitoring bicarbonate levels
- Sodium bicarbonate supplements when appropriate
- Dialysis in advanced kidney failure
Dehydration or diarrhea
Treatment may include:
- Fluids
- Electrolyte replacement
- Treatment of illness causing dehydration or diarrhea
Sepsis or lactic acidosis
Treatment may include:
- Antibiotics
- IV fluids
- Oxygen support
- Hospital or intensive care treatment
Alcohol-related ketoacidosis
Treatment may include:
- IV fluids to treat dehydration
- Glucose (sugar) to help stop ketone production
- Electrolyte replacement
- Treatment for alcohol withdrawal, if needed
- Monitoring in a hospital setting
Starvation ketoacidosis
Treatment may include:
- Gradually restoring nutrition
- Fluids and electrolyte replacement
- Treating any underlying illness that contributed to poor food intake
- Monitoring to ensure the body safely returns to a normal metabolic balance
Because treatment varies widely, it is important not to attempt self-treatment for suspected metabolic acidosis. Talk to your health care provider or a Banner Health specialist.
Can metabolic acidosis be prevented?
While not every health issue can be avoided, managing underlying conditions might reduce your risk. Some helpful steps include:
- Managing diabetes as your doctor recommends
- Taking your medications as prescribed
- Staying well-hydrated
- Seeking medical help if you have severe diarrhea or vomiting
It’s also important to follow your kidney disease treatment plan and seek prompt care for serious infections. Regular checkups and lab tests can help find problems early and keep you healthier.
The bottom line
Metabolic acidosis happens when too much acid builds up in the body. Usually, it’s a sign of another health problem, not a disease itself. Common causes include diabetic ketoacidosis, kidney disease, severe infections, dehydration and long-lasting diarrhea.
Since symptoms can vary and may resemble those of other conditions, doctors usually run blood tests to diagnose it. Some cases are mild but others can be life-threatening and need emergency care.
If you are concerned about symptoms or have a chronic condition that increases your risk, a Banner Health primary care provider or specialist can help review your symptoms, lab results and next steps.
Frequently asked questions
What is the most common cause of metabolic acidosis?
Common causes include diabetic ketoacidosis, chronic kidney disease, severe diarrhea and lactic acidosis caused by serious illness or infection.
Can metabolic acidosis go away on its own?
It depends on the cause. Mild cases may improve when the underlying problem is treated but severe cases often require urgent medical care.
Is metabolic acidosis a disease?
No. Metabolic acidosis is usually a condition or lab finding that signals an underlying health problem.
Can dehydration cause metabolic acidosis?
Yes. Severe dehydration can lead to metabolic acidosis, especially if combined with diarrhea, infection or other illnesses.
Can kidney disease cause metabolic acidosis?
Yes. The kidneys help remove acid from the body. When the kidneys don’t work well, acids can build up in the blood.
What blood tests diagnose metabolic acidosis?
Providers often use blood tests such as a metabolic panel, blood gas tests, kidney function tests, glucose tests and lactate level checks to diagnose metabolic acidosis and determine its cause.
