What risks does metabolic acidosis entail for the patient?
The risks that metabolic acidosis pose to the patient arise from multiple mechanisms:
• There is risk engendered by the underlying disorder responsible for the metabolic acidosis (e.g., shock).
• There are the adverse effects of high [H + ] (binding of H + to intracellular proteins in vital organs (e.g., brain and heart), as well as possible dangers associated with the anions that accompany the H + load (e.g., chelation of ionized calcium during citric acidosis).
• There are risks from toxins produced in the metabolic process that lead to the production of these acids (e.g., formaldehyde produced during the metabolism of methanol to formic acid or glycoaldehyde produced during metabolism of ethylene glycol to glycolic acid) or as a marker of a serious metabolic threat (e.g., production of pyroglutamic acid after overdoses of acetaminophen, as this indicates depletion of the reduced form of glutathione—the protein that scavenges reactive oxygen species).