Acidosis
Acidosis is a condition in which there is too much acid in the body fluids. It is the
opposite of alkalosis (a condition in which there is too much base in the body
fluids).
Causes
The kidneys and lungs maintain the balance (proper pH level) of chemicals called
acids and bases in the body. Acidosis occurs when acid builds up or when
bicarbonate (a base) is lost. Acidosis is classified as either respiratory or
metabolic acidosis.
Respiratory acidosis develops when there is too much carbon dioxide (an acid)
in the body. This type of acidosis is usually caused when the body is unable to
remove enough carbon dioxide through breathing. Other names for respiratory
acidosis are hypercapnic acidosis and carbon dioxide acidosis. Causes of
respiratory acidosis include:
Chest deformities, such as kyphosis
Chest injuries
Chest muscle weakness
Long-term (chronic) lung disease
Neuromuscular disorders, such as myasthenia gravis, amyotrophic lateral
sclerosis or muscular dystrophy
Overuse of sedative drugs, causing decreased respiration
Acute lung disease, such as severe pneumonia or acute respiratory distress
syndrome associated with severe medical illness
Metabolic acidosis develops when too much acid is produced in the body. It can
also occur when the kidneys cannot remove enough acid from the body. There
are several types of metabolic acidosis:
Diabetic acidosis (also called diabetic ketoacidosis and DKA) develops when
substances called ketone bodies (which are acidic) build up during
uncontrolled diabetes (usually type 1 diabetes).
Hyperchloremic acidosis is caused by the loss of too much sodium
bicarbonate from the body, which can happen with severe diarrhea.
Kidney disease (uremia, distal renal tubular acidosis or proximal renal
tubular acidosis).
Lactic acidosis.
Poisoning by aspirin, ethylene glycol (found in antifreeze), or methanol.
Severe dehydration.
Lactic acidosis is a buildup of lactic acid. Lactic acid is mainly produced in muscle
cells and red blood cells. It forms when the body breaks down carbohydrates to
use for energy when oxygen levels are low. This can be caused by:
Cancer
Carbon monoxide poisoning
Drinking too much alcohol
Exercising vigorously for a very long time
Liver failure
Low blood sugar (hypoglycemia)
Medicines, such as salicylates, metformin, anti-retrovirals
MELAS (a very rare genetic mitochondrial disorder that affects energy
production)
Prolonged lack of oxygen from shock, heart failure, or severe anemia
Seizures
Sepsis -- severe illness due to infection with bacteria or other germs
Severe asthma
Compensated acidosis occurs when the body returns the acid-base balance to
near normal in cases of acidosis, but bicarbonate and carbon dioxide levels
remain abnormal.
Symptoms
Metabolic acidosis symptoms depend on the underlying disease or condition.
Metabolic acidosis itself causes rapid and deep breathing as your body tries to
compensate for it. Confusion or lethargy may also occur. Severe metabolic
acidosis can lead to shock or death. In some situations, metabolic acidosis can be
a mild, ongoing (chronic) condition.
Respiratory acidosis symptoms can include:
Confusion
Fatigue
Lethargy
Shortness of breath
Sleepiness
Exams and Tests
Your health care provider will perform a physical examination and ask about your
symptoms.
These tests can help diagnose acidosis. They can also determine whether the
cause is a breathing problem or a metabolic problem. Tests may include:
Arterial or venous blood gas analysis
Basic metabolic panel (group of blood tests that measure sodium and
potassium levels, kidney function, and other chemicals and functions) to
show whether the type of acidosis is metabolic or respiratory
Blood ketones
Lactic acid test
Urine ketones
Urine pH
Other blood tests may be needed to determine the cause of the acidosis.
Other tests that may be needed to determine the cause of the acidosis include:
Chest x-ray
CT abdomen
Urinalysis
Urine pH
Treatment
Treatment is aimed at the health problem causing the acidosis. In some cases,
sodium bicarbonate (the chemical in baking soda) may be given to reduce the
acidity of the blood. Often, you will receive lots of fluids through your vein.
Outlook (Prognosis)
Acidosis can be dangerous if untreated. Many cases respond well to treatment.
The outlook will depend on the underlying disease causing the condition.
Possible Complications
Complications depend on the specific type of acidosis.
When to Contact a Medical Professional
All the types of acidosis will cause symptoms that require treatment by your
provider.
Prevention
Prevention depends on the cause of the acidosis. Many causes of metabolic
acidosis can be prevented, including diabetic ketoacidosis and some causes of
lactic acidosis. Normally, People with healthy Kidneys and Lungs do not have
serious acidosis.
Metabolic acidosis
Metabolic acidosis is a condition in which there is too much acid in the body fluids.
Causes
Metabolic acidosis develops when too much acid is produced in the body. It can also occur
when the kidneys cannot remove enough acid from the body. There are several types of
metabolic acidosis:
Diabetic acidosis (also called diabetic ketoacidosis and DKA) develops when substances
called ketone bodies (which are acidic) build up during uncontrolled diabetes (usually
type 1 diabetes).
Hyperchloremic acidosis is caused by the loss of too much sodium bicarbonate from the
body, which can happen with severe diarrhea.
Kidney disease (uremia, distal renal tubular acidosis or proximal renal tubular acidosis).
Lactic acidosis.
Poisoning by aspirin, ethylene glycol (found in antifreeze), or methanol.
Severe dehydration.
Lactic acidosis results from a buildup of lactic acid. Lactic acid is mainly produced in muscle cells
and red blood cells. It forms when the body breaks down carbohydrates to use for energy when
oxygen levels are low. It can be caused by:
Cancer
Carbon monoxide poisoning
Drinking too much alcohol
Exercising vigorously for a very long time
Liver failure
Low blood sugar (hypoglycemia)
Medicines, such as salicylates, metformin, anti-retrovirals
MELAS (a very rare genetic mitochondrial disorder that affects energy production)
Prolonged lack of oxygen from shock, heart failure, or severe anemia
Seizures
Sepsis -- severe illness due to infection with bacteria or other germs
Severe asthma
Symptoms
Most symptoms are caused by the underlying disease or condition that is causing the metabolic
acidosis. Metabolic acidosis itself causes rapid and deep breathing as your body tries to
compensate for it. Confusion or lethargy may also occur. Severe metabolic acidosis can lead to
shock or death. In some situations, metabolic acidosis can be a mild, ongoing (chronic)
condition.
Exams and Tests
Your health care provider will perform a physical examination and ask about your symptoms.
These tests can help diagnose acidosis. They can also determine whether the cause is a
breathing problem or a metabolic problem. Tests may include:
Arterial or venous blood gas
Basic metabolic panel, (a group of blood tests that measure your sodium and potassium
levels, kidney function, and other chemicals and functions)
Blood ketones
Lactic acid test
Urine ketones
Urine pH
Other blood tests may be needed to determine the cause of the acidosis.
Other tests that may be needed to determine the cause of the acidosis include:
Chest x-ray
CT abdomen
Urinalysis
Urine pH
Treatment
Treatment is aimed at the health problem causing the metabolic acidosis. In some cases,
sodium bicarbonate (the chemical in baking soda) may be given to reduce the acidity of the
blood. Often, you will receive lots of fluids through your vein.
Outlook (Prognosis)
Metabolic acidosis can be dangerous if untreated. Many cases respond well to treatment. The
outlook will depend on the underlying disease causing the condition.
Possible Complications
Very severe metabolic acidosis can lead to shock or death.
When to Contact a Medical Professional
Seek medical help if you have symptoms of any disease that can cause metabolic acidosis.
Prevention
Diabetic ketoacidosis can be prevented by keeping type 1 diabetes under control and
responding promptly if the blood sugar stays above 250 mg/dL for over 12 hours.
Alternative Names
Acidosis - metabolic
Respiratory acidosis
Respiratory acidosis is a condition that occurs when your lungs can’t remove all of the carbon
dioxide produced by your body. This causes the blood and other body fluids to become too
acidic.
Causes
There are many causes of respiratory acidosis, including:
Airway diseases, such as asthma and COPD
Lung tissue diseases, such as pulmonary fibrosis, which causes scarring and thickening of
the lungs
Diseases that can affect the chest, such as scoliosis
Diseases that affect the nerves and muscles that signal the lungs to inflate or deflate
Medicines that suppress breathing, including narcotics (opioids), and "downers," such as
benzodiazepines, often when combined with each other or alcohol
Severe obesity, which restricts how much the lungs can expand
Obstructive sleep apnea
Chronic respiratory acidosis occurs over a long time. This leads to a stable situation, because
the kidneys increase body chemicals, such as bicarbonate, that help restore the body's acid-
base balance.
Acute respiratory acidosis occurs when carbon dioxide builds up very quickly, before the
kidneys can return the body to a state of balance.
Some people with chronic respiratory acidosis get acute respiratory acidosis when a serious
illness worsens their condition and disrupts their body's acid-base balance.
Symptoms
Symptoms may include:
Confusion
Anxiety
Easy fatigue
Lethargy
Shortness of breath
Sleepiness
Tremors (shaking)
Warm and flushed skin
Sweating
Exams and Tests
Your health care provider will perform a physical exam and ask about symptoms.
You may have certain tests, including:
Arterial blood gas (measures oxygen and carbon dioxide levels in the blood)
Basic metabolic panel
Chest x-ray
CT scan of the chest
Pulmonary function test to measure breathing and how well the lungs are functioning
Ultrasound of the heart (echocardiogram)
Treatment
Treatment is aimed at the underlying disease, and may include:
Bronchodilator medicines and corticosteroids to reverse some types of airway
obstruction
Noninvasive positive-pressure ventilation (called CPAP or BiPAP)
Oxygen if your blood oxygen level is low
Treatment to stop smoking.
Changing medicines when appropriate
If your case is severe, you may need to be put on a breathing machine (ventilator).
Outlook (Prognosis)
How well you do depends on the disease causing the respiratory acidosis.
Possible Complications
Complications may include:
Poor organ function
Respiratory failure
Shock
When to Contact a Medical Professional
Severe acute respiratory acidosis is a medical emergency. Seek medical help right away if you
have symptoms of this condition.
Call your provider if you have symptoms of lung disease that suddenly get worse.
Prevention
DO NOT smoke. Smoking can lead to many severe lung diseases that can cause respiratory
acidosis.
Losing weight may help prevent respiratory acidosis due to obesity (obesity-hypoventilation
syndrome).
Be careful about taking sedating medicines, and never combine these medicines with alcohol.
Use your CPAP device regularly if it has been prescribed for you.
Alternative Names
Ventilatory failure; Respiratory failure; Acidosis - respiratory
