Chronic metabolic acidosis is commonly associated with conditions such as chronic kidney disease (CKD) and renal tubular acidosis (RTA). In these cases, the management goal is to correct the ongoing acid load and prevent complications such as bone demineralization, muscle wasting, and progression of CKD.
Oral Bicarbonate Therapy
In patients with chronic metabolic acidosis, oral bicarbonate or sodium citrate is typically used to raise serum bicarbonate levels to at least 22–23 mmol/L. Sodium citrate is often preferred over bicarbonate because it is less likely to cause gastrointestinal discomfort. In patients with concomitant hypokalemia, potassium citrate is used.
Dietary Modifications
In patients with CKD, reducing dietary acid load by limiting protein intake or increasing fruit and vegetable consumption may help to control chronic acidosis. These dietary changes can reduce acid production and slow the progression of CKD.
Mineralocorticoid Therapy
In patients with hyporeninemic hypoaldosteronism (type 4 RTA), mineralocorticoid therapy can be used to correct hyperkalemia and acidosis. However, this treatment must be used cautiously in patients with hypertension.
Dialysis
In patients undergoing hemodialysis or peritoneal dialysis, adjusting the bicarbonate concentration in the dialysate can help maintain normal acid-base balance. Dialysate with a higher bicarbonate concentration (40 mmol/L) is commonly used to correct metabolic acidosis in patients on hemodialysis.
