Abstract

Background: Metabolic acidosis represents a complex acid-base disorder requiring precise diagnostics and a rational therapeutic approach. Objective: This work presents principles of treatment for metabolic acidosis, with a focus on indications and restrictions for different therapeutic modalities. Methods: Overview of contemporary therapeutic approaches to metabolic acidosis, including bicarbonates, alternative buffer systems and specific therapies. Results: Treatment of metabolic acidosis requires an individualized approach. Hemodialysis is indicated for renal insufficiency or poisoning. Intravenous application of bicarbonate is reserved for the severe cases (pH ≤ 7.20, PaCO ₂ < 45 mmHg) when there is acidosis resulting in loss of bicarbonate or accumulation of inorganic acid with normal anionic gap. Application of bicarbonate is potentially harmful in cases of accumulation of organic acids with increased anionic gap. Alternatives to bicarbonate include lactate (Ringer's solution), sodium acetate, and tromethamine. Conclusion: Successful treatment of metabolic acidosis requires understanding the pathophysiological mechanisms and precise assessment of indications for specific therapeutic modalities.

Key words: metabolic acidosis, sodium bicarbonate, tromethamine, lactate, anionic gap