Background: Chronic liver disease (CLD) is associated with multiple metabolic derangements, including disturbances in acid–base balance due to impaired lactate metabolism, reduced hepatic clearance, and systemic complications. Metabolic acidosis, particularly lactic acidosis, has been associated with disease severity and adverse outcomes in cirrhotic patients.

Aim: To evaluate the association between metabolic acidosis and severity of chronic liver disease using Child–Pugh classification and MELD score, and to assess its relationship with complications such as hepatic encephalopathy, hepatorenal syndrome, and ascites.

Methods: This prospective cross-sectional observational study included 96 patients diagnosed with chronic liver disease admitted to a tertiary care hospital between September 2022 and August 2024. Arterial blood gas analysis was performed to assess acid–base status, including pH, bicarbonate, base excess, and lactate levels. Clinical, biochemical, and radiological parameters were recorded. Disease severity was assessed using Child–Pugh and MELD-Na scores. Statistical analysis was performed using SPSS version 20.

Results: The study population was predominantly male (96.9%), with alcohol being the most common etiology (93.8%). Metabolic acidosis was observed in 46.8% of patients, while respiratory alkalosis was seen in 12.5%. Among patients with metabolic acidosis, 80% belonged to Child–Pugh Class C and 20% to Class B. A higher proportion of patients with metabolic acidosis had elevated MELD-Na scores (20–39), indicating increased disease severity and mortality risk. Metabolic acidosis was more frequently observed in patients with complications such as ascites, hepatic encephalopathy, and hepatorenal syndrome.