Severe metabolic acidosis in critically Ill patients and its association with the outcome in North Karnataka


  • S. M. Biradar Department of Medicine, Shri B. M. Patil Medical College, Hospital and Research Center, Vijayapura, Karnataka, India
  • Renuka Holyachi Department of Anaesthesia, Shri B. M. Patil Medical College, Hospital and Research Center, Vijayapura, Karnataka, India
  • V. Ravi Teja Department of Medicine, Shri B. M. Patil Medical College, Hospital and Research Center, Vijayapura, Karnataka, India



Acid-base disorders, Critical illness, Metabolic acidosis


Background: Outcomes of metabolic acidosis remain unsure and needs to be explored deeply. This article presents a rational approach to diagnosis and management of metabolic acidosis. The data focusing specifically on severe metabolic acidosis (pH<7.20) is scanty.  

Methods: It was a prospective observational study. A total of 50 consecutive critically ill patients (APACHE II score of 18 or more) with single severe metabolic acidosis (pH<7.20) admitted to the intensive care units (ICUs) of Shri BM Patil Medical College, Vijayapura. Arterial blood gas analysis along with other relevant investigations was done within first 24 h of ICU admission.

Results: Among 50 patients, 32 patients expired compared to 18 patients who were discharged from hospital in stable condition. Out of 29 patients, who had lactic acidosis, 21 (72%) patients died compared to 8 (28%) patients who were discharged in stable condition. Out of 22 patients who have low Strong Ion Difference (SID) 16 patients had expired (76%) remaining 6 (24%) patients are discharged at stable condition. Out of 27 patients who were put on mechanical ventilator on the first day, 22 (80%) patients expired. 18 patients required vasopressor support on admission out of which 16 (90%) patients had lactic acidosis.  

Conclusions: Lactic acidosis and strong ion gap are found to be associated with higher mortality. Hypotensive patients required vasopressor support on admission. Monitoring of serum pH, HCO3, lactate levels and strong ion gap may have prognostic and therapeutic implications.



Gunnerson KJ. Clinical review: The meaning of acid-base abnormalities in the intensive care unit. Crit Care 2005;9:508-16.

Kellum JA, Song M, Subramanian S. Acidemia: Good, bad or inconsequential? In:, editor. In Yearbook of Intensive Care and Emergency Medicine. Springer. 2002:510-16.

Li J, Hoskote A, Hickey C, Stephens D, Bohn D, Holtby H, et al. Effect of carbon dioxide on systemic oxygenation, oxygen consumption, and blood lactate levels after bidirectional superior cavopulmonary anastomosis. Crit Care Med 2005;33:984-9.

Kraut JA, Madias NE. Metabolic acidosis: pathophysiology, diagnosis and management. Nat Rev Nephrol 2010;6:274-85.

Jung B, Rimmele T, Le Goff C, Chanques G, Corne P, Jonquet O, et al. Severe metabolic or mixed acidemia on intensive care unit admission: incidence, prognosis and administration of buffer therapy. A prospective, multiple-center study. Crit Care 2011;15:R238.

Smith I, Kumar P, Molloy S, Rhodes A, Newman PJ, Grounds RM, et al. Base excess and lactate as prognostic indicators for patients admitted to intensive care. Intensive Care Med 2001;27:74-83.

Prem A. Metabolic acidosis in medical intensive care unit with indicators and their prognostic value-A prospective observational study. As J Medica Sci. 2017;8.3:60-7.

Kraut JA, Kurtz I. Use of base in the treatment of acute severe organic acidosis by nephrologists and critical care physicians: results of an online survey. Clin Exp Nephrol 2006;10:111-7.

Gehlbach BK, Schmidt GA. Bench-to-bedside review: treating acid-base abnormalities in the intensive care unit - the role of buffers. Crit Care 2004;8:259-65.

Stacpoole PW. Lactic acidosis: the case against bicarbonate therapy. Ann Intern Med 1986;105:276-9.

Adeva-Andany MM, Fernández-Fernández C, Mouriño-Bayolo D, Castro- Quintela E, Domínguez-Montero A. Sodium bicarbonate therapy in patients with metabolic acidosis. Scient World J. 2014;2014:627-73.

Duhon B, Attridge RL, Franco-Martinez AC, Maxwell PR, Hughes DW. Intravenous sodium bicarbonate therapy in severely acidotic diabetic ketoacidosis. Ann Pharmacother. 2013;47:970-5.






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