Dilutional acidosis or uncovered cellular metabolism?

Excerpt

Metabolic acidosis is common in critically ill patients admitted with hypovolaemic and/or septic shock. Following resuscitation with appropriate parenteral fluids, although the patient may be clinically improving, in terms of changes in blood pressure and urine output, repeat blood gas analysis may show a fall in arterial pH [1]. Similarly patients undergoing general anaesthesia may develop a metabolic acidosis intra- or postoperatively that spontaneously resolves within 24 h [2]. This fall in arterial pH may appear somewhat paradoxical compared to the clinical state. It was initially suggested that the administration of intravenous fluids produced a dilutional acidosis, because of a dilution of plasma bicarbonate, with continued tissue respiration and carbon dioxide generation [3]. …