title: [Metabolic acidosis].
abstract: Metabolic acidosis is frequently observed in clinical practice, especially among critically ill patients and/or in the course of renal failure. Complex mechanisms are involved, in most cases identifiable by medical history, pathophysiology-based diagnostic reasoning and measure of some key acid-base parameters that are easily available or calculable. On this basis the bedside differential diagnosis of metabolic acidosis should be started from the identification of the two main subtypes of metabolic acidosis: the high anion gap metabolic acidosis and the normal anion gap (or hyperchloremic) metabolic acidosis. Metabolic acidosis, especially in its acute forms with elevated anion gap such as is the case of lactic acidosis, diabetic and acute intoxications, may significantly affect metabolic body homeostasis and patients hemodynamic status, setting the stage for true medical emergencies. The therapeutic approach should be first aimed at early correction of concurrent clinical problems (e.g. fluids and hemodynamic optimization in case of shock, mechanical ventilation in case of concomitant respiratory failure, hemodialysis for acute intoxications etc.), in parallel to the formulation of a diagnosis. In case of severe acidosis, the administration of alkalizing agents should be carefully evaluated, taking into account the risk of side effects, as well as the potential need of renal replacement therapy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Regolisti
authors.forename: Filippo
authors.initials: F
authors.lastname: Fani
authors.forename: Riccardo
authors.initials: R
authors.lastname: Antoniotti
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Castellano
authors.forename: Elena
authors.initials: E
authors.lastname: Cremaschi
authors.forename: Paolo
authors.initials: P
authors.lastname: Greco
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Parenti
authors.forename: Santo
authors.initials: S
authors.lastname: Morabito
authors.forename: Alice
authors.initials: A
authors.lastname: Sabatino
authors.forename: Enrico
authors.initials: E
authors.lastname: Fiaccadori
mesh_terms: D000138:Acidosis / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D000465:Algorithms; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D011379:Prognosis