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Metabolic & Endocrine Effects of Metabolic Acidosis in Humans

etabolic acidosis is an important acid-base disturbance in humans. It is characterized by a primary decrease in body bicarbonate stores and is known to induce multiple endocrine and metabolic alterations. Metabolic acidosis induces nitrogen vesting and in humans, depresses protein metabolism. Meabolic acidosis induces a negative calcium balance (resorption from bone) with hypercalciurea and a propensity to develop kidney stones. Metabolic acidosis also results in hypophosphataemia due to renal phosphate wasting. Negative calcium balance and phosphate depletion combine to induce a metabolic bone disease that exhibits features of both osteoporosis and osteomalacia. In humans at least, 1,25-(OH)2 vitamin D levels increase, probably through phophate depletion-induced stimulation of 1-alpha hydroxylase. The production rate of 1,25- (OH)2 vitamin D is thus stimulated, and parathyroid hormone decreases secondarily. There is experimental evidence to support the notion that even mild degrees of acidosis, such as that occurring by digestion of high animal protein diet, induces some of these metabolic and endocrine effects. The possible role of diet-induced acid loads in nephrolithiasis, age-related loss of lean body mass and osteoporosis is discussed.

M Wiederkehr, R Krapf, Swiss Med Wkly 2001;131:127-132


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