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Metabolic Acidosis

Metabolic acidosis occurs when the chemical balance of acids and bases in the body become imbalanced. This can be a result of the body producing excess acid, not sufficiently ridding itself of acid, or an insufficient amount of base to offset a normal amount of acid. When any of these situations occur, chemical reactions and processes within your body work incorrectly which can result in either life-threatening episodes or mild episodes of metabolic acidosis.

When our lawyers look at metabolic acidosis, it is usually in the context of a birth injury claim. Our concern when we see metabolic acidosis is that this is a clinical marketer for ischemia. Babies with ischemia are not getting enough blood flow throughout the body which may mean the child's vital organs are not getting the oxygen they need. It is not possible to directly measure blood flow throughout the body, acidosis tells us that there is a problem. So while acidosis is not a diagnosis of brain ischemia, it is a diagnosis of an abnormality of the normal function of cells which almost invariably function without creating acid. Metabolic acidosis and the total duration of acidosis and longest single episode of acidosis are correlated with a cognitive and motor function delays.

It is unclear whether acidosis is just a marker for brain injury or a cause of brain injury. Defense experts in medical malpractice cases often take the position that metabolic acidosis is not a diagnosis of brain ischemia but rather a diagnosis of that there is a abnormality of the normal function of cells which usually function without creating acid. Other experts have testifed in birth injury malpractice cases that acidosis itself has circulatory depressant effects and not just an indicator that tissue perfusion is inadequate.

The condition is sometimes treatable, but treatment is dependent on what the underlying cause is.

Causes of Metabolic Acidosis

Acid-base imbalances in your blood resulting in metabolic acidosis or metabolic alkalosis (excess base) can be caused by a number of things including:

  • Ketoacidosis occurs when your body does not produce enough insulin and you become dehydrated, usually as a result of diabetes. When this happens, your body will burn fat instead of carbs, which in turn produces ketones. When ketones accumulate in large numbers, they cause your blood to become acidic. This condition can also occur from people consuming alcohol in large quantities while not eating, or in people who do not eat at all for extended periods of time.
  • Lactic acidosis occurs when your cells produce lactic acid as a result of a shortage of oxygen. When this happens, lactic acid then builds up in your blood. This can occur due to excessive or intense exercise, large drops in blood pressure, heart failure, cardiac arrest, or severe infections.
  • Renal tubular acidosis occurs as a result of kidney disease as well as some other immune system and genetic disorders that can damage your kidneys. This type of metabolic acidosis is caused by improper kidney function where your kidneys insufficiently remove acid from your blood that would ordinarily be disposed of through urine by healthy kidneys.
  • Hyperchloremic acidosis occurs as a result of low levels of bicarbonate, which is the base that helps neutralize acids in the blood. Bicarbonate can become depleted due to severe diarrhea, laxative abuse, and kidney problems.
  • Respiratory acidosis occurs as a result of there being too much carbon dioxide in your body, generally caused by issues with lung function. When this happens, it results in blood that is hyper-acidic.

Symptoms of metabolic acidosis or metabolic alkalosis can include, among others, excessively fast breathing, fast heart rate, confusion, fatigue, little appetite, nausea, and fruity-smelling breath, a very common symptom of diabetic ketoacidosis.

Risks Factors

If you develop metabolic acidosis and it goes untreated, it can result in kidney stones, chronic kidney problems, kidney failure, bone disease, and delayed growth. When metabolic acidosis is caught and treated early enough, many people can recover fully; however, in serious cases patients can have issues with organ function, respiratory failure, kidney failure, shock, or death.

Metabolic Acidosis Malpractice

NewbornA physician caring for a patient who has or is at risk of developing metabolic acidosis is responsible, like any other physician, to exercise the degree of care and skill that a physician should use given the circumstances. Metabolic acidosis malpractice occurs when a physician falls short of the standard of care in preventing metabolic acidosis, diagnosing metabolic acidosis, or treating metabolic acidosis. In many cases, metabolic acidosis is actually the result of medical malpractice or negligent care.

Metabolic Acidosis Malpractice Verdicts and Settlements

Summarized below are recent verdicts and reported settlements from medical malpractice cases involving metabolic acidosis. These case descriptions are provided for informational purposes only.

  • Saldana v. Davita Health Care Partners (Colorado 2018) $383.5 million: This case was brought by the families of three deceased patients who died as a result of metabolic alkalosis, a condition where there is excess base in the blood that causes the pH to rise above normal and can increase the risks of cardiac arrest. Patients all received dialysis treatments at clinics run by the defendant and died shortly after via cardiac arrest. The defendant used a product to treat the deceased patients called GranuFlo, which had been recalled in 2012 for causing toxic pH imbalances in the blood. GranuFlo is a product that is supposed to help remove waste products and maintain proper pH levels in the blood. The plaintiffs alleged that the defendant was negligent in failing to inspect and review the composition of GranuFlo, follow the manufacturer's recommendations and instruction for use, properly educate physicians on the risk and safe use of GranuFlo, and concealed facts from the physicians and patients regarding GranuFlo. The case went to trial and the jury awarded a verdict of $383.5 million that was split accordingly between the three families.
  • I.K.A. v. United States of America (Nevada 2017) $5 million: Plaintiff was a newborn female treated at a federal hospital who suffered, among other conditions, from metabolic acidosis. The plaintiff claimed her mother had been receiving prenatal care at the hospital and then went there for the induction of labor and a cesarean section. An anesthesiologist was not immediately available, which delayed delivery, and three hours later a cesarean section was performed due to fetal distress. At birth, the plaintiff had no heartbeat, was not breathing, was limp, and had no tone. Plaintiff sued alleging hospital was negligent in failing to recognize developing fetal acidosis and the need for an expedited delivery, failing to perform a timely cesarean section, failing to have a neonatal resuscitation team in place, and failing to provide adequate neonatal resuscitation. The defendant denied all liability but the jury awarded a verdict of $5 million.
  • Mendez v. Logan General Hospital (West Virginia 2013) $250,000 thousand: This case concerned a wrongful death action brought on behalf of a 51 year-old deceased patient who died from metabolic acidosis. The deceased patient was treated in the hospital for shock pulmonary edema for 15 days and then discharged, despite having a large ulcer on her lower back which continued to go untreated. Plaintiff alleged the defendant was negligent in failing to take appropriate measures to prevent the wound and failing to assess and document the wound which eventually turned septic and caused metabolic acidosis. The case did not go to trial and the parties settled for $250,000 thousand.
  • Bravo v. United States of America (Florida 2005) $60,485,789 million: This medical malpractice action was brought against an OB/GYN at a federal hospital. The plaintiff alleged that the defendants failed to timely perform a caesarean section, despite there being evidence of fetal distress, and then allowed the distress to continue for an additional six hours. The plaintiff's son was then born with catastrophic and permanent brain damage that was caused by metabolic acidosis. This resulted from compression of the umbilical cord which obstructed blood flow to the baby and reduced his oxygen supply, ultimately causing the baby to become acidotic which then went untreated for six hours. The case went to trial where the jury awarded the plaintiff a sum of $60,485,789 including economic damages of $1,973,112 in lost earning capacity, $7,809,769 in future medical expenses, $99,025 in past medical expenses, $603,883 in the mother's loss of earning capacity as well as non-economic damages including $10 million to the child, $25 million to the mother, and $15 million to the father.
  • Sanders v. United States of America (Washington 2006) $7,600,201 million: This case involved a patient who was improperly delivered at birth and as a result, suffered from metabolic acidosis that left him with brain damage, spastic quadriplegia, bilateral pneumothorax, and speech impairment. The plaintiff alleged that the defendant hospital failed to properly train and supervise its medical staff, failed to properly maintain its facility, failed to properly deliver the plaintiff, and failed to take evasive actions to treat his deteriorating condition quickly and efficiently violating the standard of care. The defendant denied all liability and the case went to trial where the jury awarded a verdict of $7,600,201 million.
Your Child's Birth Injury Claim

If you or a loved one has suffered an injury as a result of metabolic acidosis and you think your physician may have made a mistake, we can help you explore your options and find the best path for your child and your family. Contact the lawyers at Miller & Zois today for help. We can get and review the medical records and consult with our experts to determine whether or not medical malpractice may be the cause of what happened to your child. Call us today at 800-553-8082 or request an online consultation.

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