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Acidosis – Causes, Symptoms and Treatment

Acidosis is a disturbance of the acid-base balance in which the blood becomes too acidic (pH below 7.35). It can be life-threatening and requires medical treatment.

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Things worth knowing about "Acidosis"

Acidosis is a disturbance of the acid-base balance in which the blood becomes too acidic (pH below 7.35). It can be life-threatening and requires medical treatment.

What is Acidosis?

Acidosis is a condition in which the acid-base balance of the body is disrupted, causing the pH of the blood to fall below the normal value of 7.35. The normal pH of arterial blood ranges from 7.35 to 7.45. Even small deviations from this range can significantly impair organ function and enzyme activity. Acidosis is not a disease in itself, but rather a sign of an underlying disorder that requires medical attention.

Causes and Types of Acidosis

Acidosis is classified into two main types based on its underlying cause:

Respiratory Acidosis

Respiratory acidosis develops when breathing is impaired (hypoventilation), causing excess carbon dioxide (CO₂) to accumulate in the blood. CO₂ combines with water to form carbonic acid, which lowers the pH. Common causes include:

Lung diseases such as COPD or severe asthma
Respiratory muscle paralysis (e.g., in myasthenia gravis)
Obesity hypoventilation syndrome
Sleep apnea
Overdose of respiratory depressants (e.g., opioids, sedatives)

Metabolic Acidosis

Metabolic acidosis occurs when acids accumulate in the blood or when bicarbonate (HCO₃⁻), the main blood buffer, is lost in excess. Common causes include:

Diabetic ketoacidosis in poorly controlled diabetes mellitus
Kidney failure with impaired acid excretion
Lactic acidosis due to tissue oxygen deficiency (e.g., in shock or heart failure)
Severe diarrhea causing bicarbonate loss
Poisoning (e.g., methanol, salicylates)
Starvation or extreme dieting (ketoacidosis)

Symptoms

The symptoms of acidosis depend on its severity and underlying cause. Common signs include:

Rapid, deep breathing (Kussmaul respiration) as a compensatory response in metabolic acidosis
Nausea, vomiting, and abdominal pain
General weakness and fatigue
Confusion, drowsiness, or coma in severe cases
Cardiac arrhythmias
Headaches (particularly in respiratory acidosis)

Mild acidosis may be asymptomatic and discovered incidentally during blood tests.

Diagnosis

Acidosis is primarily diagnosed using an arterial blood gas (ABG) analysis, which measures the pH, carbon dioxide partial pressure (pCO₂), bicarbonate (HCO₃⁻), and base excess (BE). Additional investigations may include:

Laboratory tests (electrolytes, kidney function, blood glucose, lactate levels)
Urinalysis to assess kidney function
Further diagnostic studies to identify the underlying cause (e.g., ECG, imaging)

Treatment

Treatment of acidosis is always directed at the underlying cause:

Respiratory acidosis: Improving ventilation through respiratory support, oxygen therapy, treatment of the lung condition, or mechanical ventilation in emergencies.
Diabetic ketoacidosis: Insulin administration, fluid and electrolyte replacement.
Lactic acidosis: Treatment of the triggering cause (e.g., shock management); sodium bicarbonate may be administered in severe cases.
Renal acidosis: Bicarbonate supplementation, dietary adjustments, and dialysis in cases of kidney failure.

In life-threatening situations, intravenous sodium bicarbonate can temporarily raise the pH, buying time for definitive treatment.

References

Kasper DL et al. (eds.) - Harrison's Principles of Internal Medicine, 21st edition, McGraw-Hill Education, 2022.
Berend K, de Vries APJ, Gans ROB - Physiological Approach to Assessment of Acid-Base Disturbances. New England Journal of Medicine, 2014; 371:1434-1445.
World Health Organization (WHO) - Management of common health problems in resource-limited settings, WHO Press, Geneva.

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