Liver Failure
There are two main ways liver failure can cause metabolic acidosis: renal dysfunction and increased acid production. Renal dysfunction occurs when the kidneys cannot remove enough acid from the blood. This can happen when the liver fails to produce enough bile acids for proper kidney function. Bile acids are needed to absorb fats and fat-soluble vitamins from the intestine.
Without enough bile acids, absorption of these nutrients is impaired, and they become trapped in the intestine, where they are metabolized into fatty acids. These fatty acids are then transported to the liver, where they are converted into ketone bodies and released into the bloodstream.
Increased acid production happens when the liver fails to metabolize proteins properly. When this happens, amino acids accumulate in the blood and are metabolized into ammonia. Ammonia is then converted into urea by bacteria in the intestine. Urea is then transported to the kidney, where it is excreted in the urine. If the liver fails to metabolize amino acids properly, ammonia levels can build up in the blood and lead to metabolic acidosis.
