Testing for Metabolic Acidosis

Biomarker Patterns

Assessment of specific biomarkers and the anion gap can help evaluate metabolic acidosis. These include:

• Amylase
• Anion Gap
• Chloride
• Ionized calcium
• Metabolic disorders, inborn errors of metabolism
• Methylmalonic acid
• Phosphorus
• Potassium
• Uric acid
• White blood cells

Decreased

• Albumin
• Bicarbonate/CO2
• G6PD enzyme

Persistent metabolic acidosis should involve a workup for inborn errors of metabolism and include evaluation of ketosis, hypoglycemia, lactatemia, organic acidemia, and mitochondrial dysfunction (Guerrero 2018).

Low-grade metabolic acidosis can occur when the body retains acid and depletes bicarbonate stores, which can be damaging to tissues and organs if prolonged. Diet is a significant factor in low-grade metabolic acidosis and should be evaluated and addressed when the body’s acid-base balance is out of balance (DiNicolantonio 2021). Diet modifications can help reduce the acid load and help alkalize the urine.

References

DiNicolantonio JJ, O'Keefe J. Low-grade metabolic acidosis as a driver of chronic disease: a 21st century public health crisis. Open Heart. 2021;8(2):e001730. doi:10.1136/openhrt-2021-001730

Guerrero, Ruben Bonilla et al. “Laboratory diagnostic approaches in metabolic disorders.” Annals of translational medicine vol. 6,24 (2018): 470. doi:10.21037/atm.2018.11.05