The Management of Metabolic Acidosis in Critical Illness: A Systematic Review

Abstract

Background:
Metabolic acidosis is a critical condition frequently encountered in intensive care units (ICUs), with diverse etiologies and associated comorbidities that significantly influence patient outcomes. This systematic review evaluates the prevalence and impact of common comorbidities, including chronic hypertension, diabetes mellitus, chronic kidney disease (CKD), sepsis, and respiratory and liver diseases, in critically ill patients with metabolic acidosis.
Methods: A comprehensive literature search was conducted using major databases to identify studies published between 2016 and 2024 that examined critical care patients with metabolic acidosis. Data on associated diseases and clinical parameters such as serum bicarbonate, potassium, creatinine levels, Sequential Organ Failure Assessment (SOFA) scores, and estimated glomerular filtration rates (eGFR) were extracted. Forest plots were generated to summarize the findings and visualize inter-study variability.
Results: The review included 40 studies encompassing a diverse critical care population. Chronic hypertension (18–98.3%), CKD (up to 49%), and sepsis (up to 89.5%) were the most frequently reported comorbidities. Chronic respiratory diseases (up to 46%) and liver diseases (up to 24.8%) were also significant contributors. CKD emerged as a predominant factor influencing the severity of metabolic acidosis, with a strong association between impaired renal function and worse outcomes. Comorbidities such as diabetes mellitus, particularly type 2 diabetes (up to 50.9%), further exacerbated acidosis through associated complications like diabetic ketoacidosis. Patients with sepsis demonstrated a higher prevalence of multiorgan dysfunction and lactic acidosis, resulting in increased mortality.
Conclusions: This review highlights the high prevalence and significant impact of comorbidities in critically ill patients with metabolic acidosis. The findings emphasize the need for individualized, multidisciplinary approaches targeting the complex interplay of comorbid conditions and acidosis. Early identification and management of key contributors, such as CKD and sepsis, are critical to improving patient outcomes. Further research is needed to develop precise therapeutic interventions for this high-risk population.