TY - JOUR T1 - Low-grade metabolic acidosis as a driver of chronic disease: a 21st century public health crisis JF - Open Heart JO - Open Heart DO - 10.1136/openhrt-2021-001730 VL - 8 IS - 2 SP - e001730 AU - James J DiNicolantonio AU - James O'Keefe Y1 - 2021/10/01 UR - http://openheart.bmj.com/content/8/2/e001730.abstract N2 - Metabolic acidosis is a chronic condition that many people in the Western world have but do not realise it.1–3 It occurs when there is retention of acid in the body, which leads to a depletion in the bicarbonate stores of the body. The term metabolic acidosis is typically used when referring to low blood pH or acidemia due to a metabolic abnormality. However, this is inappropriate as most cases of metabolic acidosis do not have acidemia. In fact, a low blood pH is typically one of the last surrogate markers to become abnormal in those with low-grade metabolic acidosis.2 This is because the body maintains a normal blood pH at the expense of bicarbonate reserves. Metabolic acidosis primarily occurs inside the cell and in the fluid that surrounds our tissues (interstitial fluid).4 When checking for metabolic acidosis the clinician should look at fasting serum bicarbonate, urinary pH (with a measurement at least 4 hours separated from the last ingested meal) and 24-hour urinary citrate levels. While there is not a universally accepted way to diagnose low-grade metabolic acidosis, this paper will help to give the clinician insights into checking for this condition in their patients.Acidemia, or too much acid in the blood, only occurs when the body’s buffering capacity can no longer maintain a normal pH level. A normal blood pH is considered to be 7.35–7.45. However, even at a normal blood pH metabolic acidosis can occur. In fact, once the blood pH falls below 7.4, there is usually acid retention in the body and low-grade metabolic acidosis.2 However, the blood pH does not drop below the normal range until metabolic acidosis has become severe. Once this occurs it is usually referred to as ‘metabolic acidosis’ by the clinician. However, this is actually acidemia (or too … ER -