What is Metabolic Acidosis? Why should we worry?

[hoops2u]

I have been talking about reddening of face and neck and profuse sweating. In the course of this thread the subject of Metabolic Acidosis came up.

I find now that I want to know more about this condition. The causes. The relief. What could happen? Is it serious? Just everything.

And please, if you will, use as much plain English as you can. Or, where that is not feasable, maybe define terminology. Thank you.

Ya'll are the BEST!!!:) :)

Peace & Blessing to all,
hoops

[Gimpy]

Sorry, wrong sandbox.

[Kira]

I just wrote a big long post and then clicked on the back arrow and lost it... grrrr... I will try to summarize again but I have to go to class in a few minutes.

First of all, I didn't bring up metabolic acidosis because I thought that it had to do with being hot and sweaty. I brought it up because I was worried about people taking too much alka-seltzer and affecting their blood pH.

First, some chemistry... When something is acid, the pH is low. When something is alkaline, the pH is high. We like to keep our blood pH very tightly regulated, between 7.35 and 7.45. So, a blood pH less than 7.35 is acid, and a blood pH greater than 7.45 is alkaline. It is called "acidosis" when the blood is too acid, and it is called "alkalosis" when the blood is too alkaline.

The major organs involved in regulating pH are the lungs and the kidneys. Your tissues generate acids during normal functioning. There is a buffer system in our blood that works to keep the pH near normal. The kidneys excrete excess acid or hang onto it, depending on our needs. We can blow off excess carbon dioxide (or hang onto it) from our lungs (carbon dioxide is acidic). When you have acidosis from a lung problem, it is called respiratory acidosis. When you have alkalosis from a lung problem, it is called respiratory alkalosis. Otherwise, it is called metabolic acidosis or alkalosis.

There are about a million reasons why you could get metabolic acidosis or alkalosis, but most of them are pretty rare or have to do with specific disease states (like kidney disease, metabolic disorders, tumor lysis syndrome in chemotherapy, etc). You can also get temporary metabolic acidosis from certain drugs/toxins (aspirin, topamax, isoniazid, carbonic anhydrase inhibitors, antifreeze) or from severe diarrhea. You can get temporary metabolic alkalosis from things like severe vomiting or from taking a lot of antacids.

I have not heard of otherwise healthy people getting metabolic acidosis from foods. I do know that people with underlying kidney disease, trouble buffering their blood, etc can have some acidosis from having diets very high in meat and do better on more fruits/vegetables. But these are people who are already ill... not people without kidney disease or metabolic issues. I will have to re-read, but maybe Mrs D was talking about acidic foods being the trigger, not acidic blood? I do not know much about that at all.

Anyway, if your blood pH is messed up, the symptoms vary greatly from person to person and with how severe the pH disturbance is. When I have been sick from it, I get vague symptoms (fatigue, "fuzzy" head, anxiety). But symptoms can range from these vague symptoms to much more severe symptoms, such as mental status changes, respiratory rate and depth changes, and electrolyte (especially potassium) disturbances, leading to seizure, coma, heart rhythm problems, cardiac arrest, and even death. Do I think you're going to end up in a coma or with cardiac arrest from taking a few alka-seltzer? No. But I was worried about the prospect of people taking them every time they eat, etc.

They can easily check for pH problems on a routine blood test that is done at most physicals, etc. It is the same test that looks at your sodium, potassium, chloride, glucose, etc levels. There is a number on there for "bicarbonate," "bicarb," "HCO3," "CO2," or "carbon dioxide." There is variation in lab standards from lab to lab, so I don't want to say what it should be. But it is a simply, widely-done test. If that test looks worrisome, there are more tests the doc can do.

Metabolic acidosis and alkalosis are easily treated, but can be severe, and so they are the kind of thing you don't want to get if you don't have to get them, you know?

I have a lot more to say but I am going to be late for class if I don't go now. I will write more later tonight (and hopefully post a link or two for you, since I babble and may have made this hard to understand).

[Kira]

So, in the last post, I tried to explain what it is.

I want to summarize and also make a couple of points.

1.) Metabolic acidosis is when your blood is more acid than it should be. Happens for tons of reasons. Can be severe symptoms or can be vague symptoms.

2.) It is NOT COMMON and you are unlikely to have it unless you have an underlying reason, like kidney disease, some respiratory diseases, or a metabolic disorder.

3.) Some medications can cause it, and if you are on one of the meds that can cause it, your doc should follow your labs. It is a simple, routine blood test.

4.) It is easy to treat as long as it is detected.


Of all the things to worry about, this is really NOT something I would be worrying about unless it turned up on my labs, I had a disease that made me prone to it, or I was taking something that can cause it.

I just read in the other post that you are on Topamax; if you are worried, you can ask your doc to check you for it.

--------------------------------

BTW, I have it for two reasons.

The main reason is that I have something called Renal Tubular Acidosis Type 2, which is a kidney problem related to my underlying disorder. The mitochondria don't work right in part of my kidneys called the proximal renal tubule, which affects how my body regulates acid/base balance.

The other reason is that I get lactic acid build-up from my metabolic disorder. This is because I have a defect in the way my body turns food into energy, and the lactic acid is a by-product of that. I only get the lactic acidosis when I am sick with metabolic decompensation.

Neither of these reasons is anything you need to worry about (unless you have my weird, rare, hereditary disorder).

I take sodium bicarbonate for it, and when I am sick with metabolic stuff they sometimes have to add bicarbonate to my IV fluids as well. But with this, the acidosis is corrected and I do fine. They were following my labs frequently for a while but now I don't have to get them checked nearly as often.

[mrsdoubtfyre]

Kira's experience is a genetic form of metabolic acidosis, if I recall correctly.
I seem to remember some Neuromuscular posts in the past about the
renal tubular issues.

Anyone with severe presentation of this usually ends up in the ER.

Acid/base chemistry is highly complex. I was going thru a reference at a clinic I used to work at, and mentioned this to a doctor there, and his response is that only the renal "people" (meaning kidney specialists) really understand it.
I used to have a link to an online Acid/base paper...but it was lost in the crash. ( I had a thread on electrolytes on the ADHD board, then).

Here is the Merck one:
http://www.merck.com/mmhe/sec12/ch159/ch159a.html
It is pretty readable.

Notice that high dose aspirin causes "acidosis" too. The mixture of AlkaSeltzer with aspirin (the one I use for burning pain) sort of balances itself out, I suspect
It really was the only OTC product that helped with my tendon injury..the pain substantially changed (naproxen and Tylenol did nothing).

Acid/base issues in the blood are what are measured typically.
If you go back however to the link I had in the other thread, on pain /acid issues at the nerve endings, that concept is quite different.

People with burning pain, like me and others with PN issues, are very familiar with this "burning".
http://www.painonline.org/acid.htm
The chemical soup of pain, however, can drop the pH at nerve endings as low as 5 or 6, which is very, very acid for a human body. It hurts. It burns. The nerve doesn’t like it and immediately sends a pain signal to the brain.

Production and activation of chemicals like prostaglandins, kinins, cytokines, potassium, and other ingredients of the chemical soup is controlled by proteins that are often kinases, meaning they attach a high energy phosphate bond to the chemical to make it active. Kinases themselves are under genetic control. Some scientists think that if too much acid is applied to a nerve for too long a period, causing the pH to be too low for too long, the genes in the nerve cells lose their control mechanisms and begin to pour out pain chemicals without regulation. This may be the core of what is happening in central pain.

Environmental physicans use TriSalts to abort an allergic reaction in the office, and often they instruct the patients to use it at home (when accidental exposures occur during the diets). The typical scenario is an elimination diet for several weeks, to remove the allergen. Then a challenge is done in the office and if positive it is aborted with TriSalts. (TriSalts are used because children cannot use aspirin). AlkaSeltzer Gold is similar and aspirin free.
This is where I learned of this way of blocking histamine. I was told, that
histamine receptor function depends on acid..and that the sudden burst of base (which is diluted out in the blood fairly quickly) blocks the histamine
reaction. This is temporary, and those patients are instructed to AVOID the
substance that triggers them. Not to medicate all day long while eating the offending substance.

Here for example is a paper discussing the role of histamine in arthritis.
http://members.tripod.com/~charles_W/arthritis2.html
I have seen other articles also discussing histamine's role in pain/inflammation.

I found the AlkaSeltzer connection by accident...while trying to use Metformin. Metformin can also cause lactic acidosis in some people. I am not even diabetic, and I had a hard time with this side effect. I found that taking
AlkaSeltzer blocked the severe diarrhea that Metformin can cause. It also blocked the burning I sometimes get in my feet. This burning is a hold over from a severe PN I developed while hypothyroid (much resolved, but not 100% with treatment with Synthroid).

So acidic tissue remains the heart of this action I believe. The oral use of bicarbonate salts is temporary, as they dilute out quickly in the blood and are buffered. But I do think a "burst" occurs, which reaches histamine receptors and some pain receptors.

I know for me, the relief from AlkaSeltzer is not just for heartburn/headache.
I feel better all over, and the generalized hot feelings and aching drop off within minutes. Considering the popularity of this product over the past 50 years or so, this overall sense of well being is appreciated by many. I find it
distinctly different than oral aspirin (which takes a long time to be absorbed) and NSAIDs like Ibuprofen, naproxen, etc.

Back in my college days, we studied the absorption of AlkaSeltzer (this discipline was new then in the late 60-'s). The absorption of aspirin in
AlkaSeltzer was similar in speed to an IV shot. And much much faster than
oral tablets. So the mixture of bicarb/aspirin in the standard formula provides
an action you cannot get from other OTC pain products. The fact that aspirin is in solution, and is not in the stomach very long also minimizes bleeding side effects often seen with aspirin tablets.

It is still aspirin, however, and should
be treated accordingly regarding side effects and interactions with other
drugs.

I use AlkaSeltzer only occasionally. And it lasts for me, into the next day.
The only time I used it heavily was with that drat tendon thing..which was blindingly acutely painful (we are in a remote area with no medical resources --a private island in a major lake.) That was 3 times a day for about 2 weeks.
I finally got some Lidoderm in the mail, and used those patches successfully
til I got home and had extensive PT which helped the most.

And that Topamax connection:eek: :rolleyes:
I cringe every time I see Topamax used in pain patients. Using a drug that decreases bicarb and can cause kidney stones, in people with acidic pain endings? How bizarre is that? :confused:

What can one do? Besides the AlkaSeltzer? Well, drink alot of fluids, for one.
Avoid drugs that reduce bicarb. And eat foods that do not contribute high
acid residues in the body. Changing the diet temporarily is easy and a good
thing to try. If it does not work, you have not risked very much.

[Kira]

Nevermind...

[hoops2u]

Metabolic Acidosis or Respiratory Acidosis is caused by an a build up of acid or carbon dioxide in the body. If it's respiratory, you'd be breathing very fast and shallow, and would have a rapid heart beat as you try to blow off the carbon dioxide. I doubt that's it because you would be on your way to the ER as we speak.

Metabolic Acidosis can be caused by couple of different things; and again, you would be pretty sick, not just flushing. If it's caused by diabetes you'd be so sick you would already be in the hospital. I can't remember the other source, but again, I doubt very much that's what you have or you would be so sick that you'd be hospitalized with batteries of test being run pronto.

I'm by no means a dr. and I haven't seen you personally, but this would be very serious and you wouldn't be looking for answers here because it could be lethal, very fast.

I think you need to not worry about this possibility and keep looking for your answers. From everything you've written, my bet would be on the medications as I had the same thing. Over a period of several months as my body got use to the pain meds it has stopped. But, I have always been one who sweats more than normal when I heat up so it didn't take much.

Good luck and try not to drive yourself crazy worry about it!

Gimpy


GIMPY PLEASE!
Give me some credit. I am not WORRIED I am not musch of a worrier. I have, a long time ago, given that to God. Trust me. Here again Pops up that oh so cumbersome word ---ASSUME---. Sillly me, I though since I said this condition came up in another thread, one might go to that other thread and read it before answering. There you would clearly see, my issues with sweating and face reddening have been completely eliminated by just some very minor adjustments in medication and diet.

Only, ONLY because I read a new word, and because sooooo many people responded to the other thread(something about sweating a lot and face red, that I too started) . I started this thread using the other as a segue into a talk on metabolic acidosis.

I am so very sorry if you misunderstood my intent. I am a very happy person who loves life and the life I live. I do so thank you for your care and concern. Please read on. Kira and Mrs. D will have some extemely interesting input I'm sure we will all gain from.

Love and Blessing to you my Dear,
hoops

[hoops2u]

Mrs.D,

I don't know what to do besides Topomax. It is working well for my seizure activity and my jerks. That is what it was prescribed for, by a neurologist. I went to see him due to extreme body jerking all throughout the day and night and occassional petit mall seizure like activity.

He didn't want to do any tests. My "hunny" went with me and also described the jerking and twitching and the seizures and Dr. felt it was easiers to try the medication first. If that didn't work, he'd run some tests. But he thought most eeg were inconclusive anyway. I wan't real impressed, but we tried the med. I figured if it didn't work, I would ask my GP for a referral elswhere.

Thanks again for you help. It's great.


And thanks to Kira too. Your info has been of great help.

I was almost comatose 2 yrs ago when I was hospitalized with fatal low potassium levels. They kept me awake all night long. Seemed like it anyway, but I also had severe diahrea(sp) for 12 days. YUUCK!!!!:(

Thanks Pals!
hoops

[Gimpy]

Excuse me? I also didn't mean anything by replying to your thread. I was only trying to ease your mind, no underlying intent. You asked a question and I replied, that's all.

Kira and Mrs. D do have wonderful input, I didn't not question it one bit. They are obviously trained in the areas they speak. I was not contradicting them or anybody else AND stated I was not an expert.

If I miss-read the title of your thread, please excuse me again. How dare I?

Now I feel like a pile of crap for trying to help, I will NEVER do it again. I thought this forum had gotten better and was a little more open to "other" posters. Same story, different names.

I went back and re-read what I wrote and I feel like I was slapped in the face, and I most certainly didn't deserve it. If you ask a question, then expect answers. On the other hand, people complain when no-one answers their questions. What are we to do? I know what I'm going to do...

Sorry, wrong sandbox.

Maybe this where I assumed you were concerned about the metabolic acidosis:


"[Originally Posted by mrsdoubtfyre
Those reading here, ask your doctor for tests, and keep copies for yourself.
You have to get your Rxs renewed, so you do have the opportunity to
ask for monitoring. If you are on Neurontin or Lyrica, a renal panel should be done anyway. (these depend on renal function for clearance).

Those on Topamax especially... because this drug CAUSES metabolic acidosis.

http://www.medscape.com/files/emedicine/topic312.htm

Acidosis from disease (renal and diabetes) is a dramatic event.
Minor acid reactions at the tissue level, are more common, and often do
not show up in tests.

A successful challenge with AlkaSeltzer or TriSalts when a suspected histamine reaction occurs, is
a clue to you that that food is activating symptoms for you. People vary in
allergic responses to food/and other allergens. So finding your triggers is
important if you want to improve your quality of life. ]

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Oh well, now I am a bit concerned. I do have a blood test every 3 months. I usually get yelled at about my cholest., not too high, around 160 I think, but she always wants it lower. But I am pretty sure that the primary reason for the test is liver functioning. I have never asked for a copy because I haven't a clue as to what any of that means. Guess I should be keeping copies, but I have so much "paper". Why do I want the copies?

I do take Topomax due to seizue activity. I really would hate to give that medication up and Neurontin is not an option. What the heck is metabolic acidosis? Should we be starting a new thread here? I think I will right now.
Anyway, again, Thank you Mrs.D I feel so special. I am not being facitious, I really do. My gosh, you have given me so much attention and I so apprectiate all your help.....

Blessings my Friend,
hoops"
__________________



GIMPY PLEASE!
Give me some credit. I am not WORRIED I am not musch of a worrier. I have, a long time ago, given that to God. Trust me. Here again Pops up that oh so cumbersome word ---ASSUME---. Sillly me, I though since I said this condition came up in another thread, one might go to that other thread and read it before answering. There you would clearly see, my issues with sweating and face reddening have been completely eliminated by just some very minor adjustments in medication and diet.

Only, ONLY because I read a new word, and because sooooo many people responded to the other thread(something about sweating a lot and face red, that I too started) . I started this thread using the other as a segue into a talk on metabolic acidosis.

I am so very sorry if you misunderstood my intent. I am a very happy person who loves life and the life I live. I do so thank you for your care and concern. Please read on. Kira and Mrs. D will have some extemely interesting input I'm sure we will all gain from.

Love and Blessing to you my Dear,
hoops