Clinical profile of patients with severe metabolic acidosis in the emergency department of the National Referral Hospital in Bhutan

Abstract

Background: Severe metabolic acidosis is a critical diagnosis for which prompt identification of underlying cause and resuscitation is crucial to prevent its high morbidity and mortality. This study was conducted to help determine the etiology and observe effective treatments of severe acidosis after the authors observed a number of adult patients with a history of alcohol consumption presenting to the Emergency Department, who on evaluation had severe metabolic acidosis. Methods: This was an observational study where all patients with severe metabolic acidosis admitted to the emergency department during the study period were included. Data regarding the clinical features, treatment provided, and outcomes were collected from medical records. Result: 38 patients were included in the study. Most participants presented with symptoms of shortness of breath, abdominal pain and vomiting. 23 participants (60.5%) had a history of chronic alcohol use while 13 (34.2%) reported binge drinking. The most common diagnoses were alcoholic ketoacidosis, sepsis, diabetic ketoacidosis and acute renal injury. Among patients without AKA, the mean lactate among patients who did not survive to discharge was 11.6. In contrast, amongst patients with AKA the initial mean lactate was 17 among those who survived to discharge. Conclusion: Identifying severe metabolic acidosis and its underlying cause is important to improve the survival of patients presenting to the emergency department. This small study raises the question that perhaps the initial lactate does not carry prognostic value in patients with AKA and lactate levels may be further elevated in areas of greater thiamine deficiency.