Metabolic acidosis is a common acid-base disturbance in critically ill patients, characterized by a decrease in blood pH due to an accumulation of hydrogen ions (H+) or a loss of bicarbonate ( \( {\mathrm{HCO}}_3^{-} \) ). Understanding its pathophysiology, diagnosis, and management is crucial in the Intensive Care Unit (ICU) setting, as it can significantly impact cellular function and overall metabolism [1, 2] [Ref: Algorithm 18.1].