Acidosis

You don't need to be Editor-In-Chief to add or edit content to WikiDoc. You can begin to add to or edit text on this WikiDoc page by clicking on the edit button at the top of this page. Next enter or edit the information that you would like to appear here. Once you are done editing, scroll down and click the Save page button at the bottom of the page.

Acidosis Classification and external resources
ICD-10	E87.2
ICD-9	276.2
DiseasesDB	87
MeSH	D000138

WikiDoc Resources for Acidosis
Articles
Most recent articles on Acidosis Most cited articles on Acidosis Review articles on Acidosis Articles on Acidosis in N Eng J Med, Lancet, BMJ
Media
Powerpoint slides on Acidosis Images of Acidosis Photos of Acidosis Podcasts & MP3s on Acidosis Videos on Acidosis
Evidence Based Medicine
Cochrane Collaboration on Acidosis Bandolier on Acidosis TRIP on Acidosis
Clinical Trials
Ongoing Trials on Acidosis at Clinical Trials.gov Trial results on Acidosis Clinical Trials on Acidosis at Google
Guidelines / Policies / Govt
US National Guidelines Clearinghouse on Acidosis NICE Guidance on Acidosis NHS PRODIGY Guidance FDA on Acidosis CDC on Acidosis
Books
Books on Acidosis
News
Acidosis in the news Be alerted to news on Acidosis News trends on Acidosis
Commentary
Blogs on Acidosis
Definitions
Definitions of Acidosis
Patient Resources / Community
Patient resources on Acidosis Discussion groups on Acidosis Patient Handouts on Acidosis Directions to Hospitals Treating Acidosis Risk calculators and risk factors for Acidosis
Healthcare Provider Resources
Symptoms of Acidosis Causes & Risk Factors for Acidosis Diagnostic studies for Acidosis Treatment of Acidosis
Continuing Medical Education (CME)
CME Programs on Acidosis
International
Acidosis en Espanol Acidosis en Francais
Businness
Acidosis in the Marketplace Patents on Acidosis
Experimental / Informatics
List of terms related to Acidosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Phone:617-525-6884

Please Take Over This Page and Apply to be Editor-In-Chief for this topic: There can be one or more than one Editor-In-Chief. You may also apply to be an Associate Editor-In-Chief of one of the subtopics below. Please mail us [2] to indicate your interest in serving either as an Editor-In-Chief of the entire topic or as an Associate Editor-In-Chief for a subtopic. Please be sure to attach your CV and or biographical sketch.

For acidosis referring to acidity of the urine, see renal tubular acidosis.

Acidosis is an increased acidity (i.e. an increased hydrogen ion concentration). If not further qualified, it refers to acidity of the blood plasma.

Generally, acidosis is said to occur when arterial pH falls below 7.35, while its counterpart (alkalosis) occurs at a pH over 7.45. Arterial blood gas analysis and other tests are required to separate the main causes.

Strictly speaking, the term acidemia would be more appropriate to describe the state of low blood pH, reserving acidosis to describe the processes leading to these states. Nevertheless, most physicians use the terms interchangeably. The distinction may be relevant where a patient has factors causing both acidosis and alkalosis, where the relative severity of both determines whether the result is a high or a low pH.

The rate of cellular metabolic activity affects and, at the same time, is affected by the pH of the body fluids. In mammals, the normal pH of arterial blood lies between 7.35 and 7.50 depending on the species (e.g. healthy human-arterial blood pH varies between 7.35 and 7.45). Blood pH values compatible with life in mammals are limited to a pH range between 6.8 and 7.8. Changes in the pH of arterial blood (and therefore the extracellular fluid) outside this range result in irreversible cell damage (Needham, 2004).

Overview

• Acidosis can either be metabolic or respiratory

  • Both are caused by low arterial pH

• Metabolic acidosis is due to an increased accumulation of acid equivalents through impairment of the regulatory ability of liver or kidneys or metabolism
• Respiratory acidosis is caused by a retention of carbon dioxide due to inadequate hypoventilation or pulmonary ventilation

Respiratory acidosis

Respiratory acidosis results from a build-up of carbon dioxide in the blood (hypercapnia) due to hypoventilation. It is most often caused by pulmonary problems, although head injuries, drugs (especially anaesthetics and sedatives), and brain tumors can also bring it on. Emphysema, chronic bronchitis, asthma, severe pneumonia, and aspiration are among the most frequent causes. It can also occur as a response to chronic metabolic alkalosis.

Blood gases show pH below 7.35 as above mentioned, and PaCO₂ will be high (>45 mmHg / 6 kPa).

The key to distinguish between respiratory and metabolic acidosis is that in respiratory acidosis, the CO₂ is increased while the bicarbonate is either normal (uncompensated) or increased (compensated). Compensation occurs if respiratory acidosis persists for days or longer and a chronic phase is entered with partial buffering of the acidosis through renal bicarbonate retention.

Metabolic acidosis

Metabolic acidosis may result from disturbances in the ability to excrete acid via the kidneys. Renal acidosis is associated with an accumulation of urea and creatinine as well as metabolic acid residues of protein catabolism.

An increase in the production of metabolic acids may also produce metabolic acidosis. For example, lactic acidosis may occur from 1) severe (PaO2 <36mm Hg) hypoxemia causing a fall in the rate of oxygen diffusion from arterial blood to tissues, or 2) hypoperfusion (e.g. hypovolemic shock) causing an inadequate blood delivery of oxygen to tissues. A rise in lactate out of proportion to the level of pyruvate, e.g. in mixed venous blood, is termed "excess lactate" and is the best indicator of an inadequate flow of oxygen into the body's mitochondria from either cause. Oxygen debt (and muscle excess lactate) is also seen in strenuous exercise. Once oxygenation is restored, the acidosis clears quickly. Another example of increased production of acids occurs in starvation and diabetic acidosis. It is due to the accumulation of ketoacids (ketosis) and reflects a severe shift from glycolysis to lipolysis for fuel needs.

Acidic poisons, iron etc., and decreased production of bicarbonate may also produce metabolic acidosis.

Metabolic acidosis can result in stimulation of chemoreceptors and so increase alveolar ventilation, leading to respiratory compensation, otherwise known as Kussmaul breathing a specific type of hyperventilation. Should this situation persist the patient is at risk for exhaustion leading to respiratory failure.

Mutations to the V-ATPase 'a4' or 'B1' isoforms result in distal renal tubular acidosis—a condition that leads to metabolic acidosis—in some cases with sensorineural deafness.

In blood gas tests, it is characterised by a low pH, low blood HCO₃, and normal or low PaCO₂. In addition to arterial blood gas one can use the anion gap to differentiate between possible causes.

The Henderson-Hasselbalch equation is useful for calculating blood pH, because blood is a buffer solution. The amount of metabolic acid accumulating can also be quantitated by using buffer base deviation, a derivative estimate of the metabolic as opposed to the respiratory component. In hypovolemic shock for example, approximately 50% of the metabolic acid accumulation is lactic acid, which disappears as blood flow and oxygen debt are corrected.

Treatment of any of the varieties of metabolic acidosis is focused upon correction of the underlying problem. However, neutralizing the acidosis with infusions of bases like sodium bicarbonate may be temporarily helpful in some critical emergencies.

Differential Diagnosis

In alphabetical order. ^{[1] [1]}

Metabolic Acidosis

• Acetazolamide
• Acute Renal Failure
• Alcoholism
• Ammonium chloride medication
• Biliary fistula
• Chronic interstitial nephritis
• Chronic Obstructive Pulmonary Disease (COPD)
• Chronic respiratory alkalosis
• CO2 intoxication
• Congenital metabolic disorders
• Congestive heart failure
• Diabetic Ketoacidosis
• Diarrhea
• Distal tubular acidosis
• Drugs, toxins
• Renal failure
• Fever
• Following chronic hyperventilation
• Glomerular/tubular retention acidosis
• Heavy physical work
• Hyperkalemic renal tubular acidosis
• Hyperventilation
• Hypovolemia
• Hypoxia
• Ileus
• Anion Gap Acidosis
• Lactic Acidosis
• Leukemia
• Lymphoma
• Mesenteric insufficiency
• Myocardial Infarction
• Normal anion gap
• Pancreatitis
• Proximal Renal Tubular Acidosis
• Pulmonary Embolism
• Sepsis
• Severe burns
• Severe hepatopathy
• Shock
• Small intestine fistula
• Starvation
• Status asthmaticus
• Therapy with carbonic anhydrase inhibitor
• Thyrotoxicosis
• Tumor
• Vasomotor ataxia

Respiratory Acidosis

• Amyotrophic Lateral Sclerosis (ALS)
• Botulism
• Brainstem injury or infarction
• Bronchospasm
• Cerebral injury or infarction
• Chest trauma
• Congestive heart failure
• Diaphragmatic paralysis
• Drugs, toxins
• Familial periodic paralysis
• Guillain-Barré syndrome
• High spinal cord injury
• Hypochloremic Acidosis
• Hypokalemic myopathy
• Inadequate mechanical ventilation
• Kyphoscoliosis
• Laryngeal spasm or edema
• Muscular Dystrophy
• Myasthenia Gravis
• Neoplasm
• Pneumonia
• Pneumothorax
• Poliomyelitis
• Polyradiculitis
• Primary hypoventilation
• Pulmonary edema
• Pulmonary embolism
• Respiratory Distress Syndrome
• Restrictive Lung Disease
• Sleep Apnea
• Smoke inhalation
• Tetanus
• Tracheal stenosis or edema

References

• Hobler KE, Carey LC. Effect of acute progressive hypoxemia on cardiac output and plasma excess lactate. Ann Surg. 1973 Feb;177(2):199-202.
• Hobler KE, Napodano RJ, Tolerance of swine to acute blood volume deficits.
• J Trauma. 1974 Aug;14(8):716-8.
• Clinical Physiology of Acid-Base and Electrolyte Disorders by Rose, Post
• Intensive Care Medicine by Irwin and Rippe
• The ICU Book by Marino
• Needham, A. 2004. Comparative and Environmental Physiology Acidosis and Alkalosis.

External links

• National Kidney and Urologic Diseases Information Clearinghouse

v • d • e Metabolic pathology / Inborn error of metabolism (E70-90, 270-279)
Amino acid	Aromatic (Phenylketonuria, Alkaptonuria, Ochronosis, Tyrosinemia, Albinism, Histidinemia) - Branched chain (Maple syrup urine disease, Propionic acidemia, Methylmalonic acidemia, Isovaleric acidemia, 3-Methylcrotonyl-CoA carboxylase deficiency) - Transport (Cystinuria, Cystinosis, Hartnup disease, Fanconi syndrome, Oculocerebrorenal syndrome) - Sulfur (Homocystinuria, Cystathioninuria) - Urea cycle disorder (N-Acetylglutamate synthase deficiency, Carbamoyl phosphate synthetase I deficiency, Ornithine transcarbamylase deficiency, Citrullinemia, Argininosuccinic aciduria, Hyperammonemia) - Glutaric acidemia type 1 - Sarcosinemia
Carbohydrate	Lactose intolerance - Glycogen storage disease (type I, type II, type III, type IV, type V, type VI, type VII) - fructose metabolism (Fructose intolerance, Fructose bisphosphatase deficiency, Essential fructosuria) - galactose metabolism (Galactosemia, Galactose-1-phosphate uridylyltransferase galactosemia, Galactokinase deficiency) - other intestinal carbohydrate absorption (Glucose-galactose malabsorption, Sucrose intolerance) - pyruvate metabolism and gluconeogenesis (PCD, PDHA) - Pentosuria - Renal glycosuria
Lipid storage	Sphingolipidoses/Gangliosidoses: GM2 gangliosidoses (Sandhoff disease, Tay-Sachs disease) - GM1 gangliosidoses - Mucolipidosis type IV - Gaucher's disease - Niemann-Pick disease - Farber disease - Fabry's disease - Metachromatic leukodystrophy - Krabbe disease Neuronal ceroid lipofuscinosis (Batten disease) - Cerebrotendineous xanthomatosis - Cholesteryl ester storage disease (Wolman disease)
Other lipid	Lipoprotein/lipidemias: Hyperlipidemia - Hypercholesterolemia - Familial hypercholesterolemia - Xanthoma - Combined hyperlipidemia - Lecithin cholesterol acyltransferase deficiency - Tangier disease - Abetalipoproteinemia Fatty acid: Adrenoleukodystrophy - Carnitine (Primary, I, II)
Mineral	Cu Wilson's disease/Menkes disease - Fe Haemochromatosis - Zn Acrodermatitis enteropathica - PO43− Hypophosphatemia/Hypophosphatasia - Mg2+ Hypermagnesemia/Hypomagnesemia - Ca2+ Hypercalcaemia/Hypocalcaemia/Disorders of calcium metabolism
Fluid, electrolyte and acid-base balance	Electrolyte disturbance - Na+ Hypernatremia/Hyponatremia - Acidosis (Metabolic, Respiratory, Lactic) - Alkalosis (Metabolic, Respiratory) - Mixed disorder of acid-base balance - H2O Dehydration/Hypervolemia - K+ Hypokalemia/Hyperkalemia - Cl− Hyperchloremia/Hypochloremia
Purine and pyrimidine	Hyperuricemia - Lesch-Nyhan syndrome - Xanthinuria
Porphyrin	Acute intermittent, Gunther's, Cutanea tarda, Erythropoietic, Hepatoerythropoietic, Hereditary copro-, Variegate
Bilirubin	Unconjugated (Gilbert's syndrome, Crigler-Najjar syndrome) - Conjugated (Dubin-Johnson syndrome, Rotor syndrome)
Glycosaminoglycan	Mucopolysaccharidosis - 1:Hurler/Hunter - 3:Sanfilippo - 4:Morquio - 6:Maroteaux-Lamy - 7:Sly
Glycoprotein	Mucolipidosis - I-cell disease - Pseudo-Hurler polydystrophy - Aspartylglucosaminuria - Fucosidosis - Alpha-mannosidosis - Sialidosis
Other	Alpha 1-antitrypsin deficiency - Cystic fibrosis - Amyloidosis (Familial Mediterranean fever) - Acatalasia

v • d • e WikiDoc Research Resources for Acidosis
Articles on Acidosis	Most recent articles on Acidosis • Most cited articles on Acidosis • Review articles on Acidosis • Articles on Acidosis in N Eng J Med, Lancet, BMJ
Media (Slides, Video, Images, MP3) on Acidosis	Powerpoint slides on Acidosis • Images of Acidosis • Photos of Acidosis • Podcasts & MP3s on Acidosis • Videos on Acidosis
Evidence Based Medicine Regarding Acidosis	Cochrane Collaboration on Acidosis • Bandolier on Acidosis • TRIP on Acidosis
Cost Effectiveness of Acidosis	Cost Effectiveness of Acidosis
Clinical Trials Involving Acidosis	Ongoing Trials on Acidosis at Clinical Trials.gov • Trial results on Acidosis • Clinical Trials on Acidosis at Google
Guidelines / Policies / Government Resources (FDA/CDC) Regarding Acidosis	US National Guidelines Clearinghouse on Acidosis • NICE Guidance on Acidosis • NHS PRODIGY Guidance • FDA on Acidosis • CDC on Acidosis
Textbook Information on Acidosis	Books and Textbook Information on Acidosis
Pharmacology Resources on Acidosis	Dosing of Acidosis • Drug interactions with Acidosis • Side effects of Acidosis • Allergic reactions to Acidosis • Overdose information on Acidosis • Carcinogenicity information on Acidosis • Acidosis in pregnancy • Pharmacokinetics of Acidosis •
Genetics, Pharmacogenomics, and Proteinomics of Acidosis	Genetics of Acidosis • Pharmacogenomics of Acidosis • Proteomics of Acidosis
Newstories on Acidosis	Acidosis in the news • Be alerted to news on Acidosis • News trends on Acidosis
Commentary on Acidosis	Blogs on Acidosis
Patient Resources on Acidosis	Patient resources on Acidosis • Discussion groups on Acidosis • Patient Handouts on Acidosis • Directions to Hospitals Treating Acidosis • Risk calculators and risk factors for Acidosis
Healthcare Provider Resources on Acidosis	Symptoms of Acidosis • Causes & Risk Factors for Acidosis • Diagnostic studies for Acidosis • Treatment of Acidosis
Continuing Medical Education (CME) Programs on Acidosis	CME Programs on Acidosis
International Resources on Acidosis	Acidosis en Espanol • Acidosis en Francais
Business Resources on Acidosis	Acidosis in the Marketplace • Patents on Acidosis
Informatics Resources on Acidosis	List of terms related to Acidosis

cs:Acidóza da:Acidose de:Azidosefr:Acidose gl:Acidose nl:Acidose no:Acidosesk:Acidóza fi:Asidoosi sv:Acidos tl:Acidosis

WikiDoc Help Menu Quick Start.. Get Started Here! How to Login How to Search Pages How to Start a New Page How to Edit a Page Cheat Sheet Editing basics Learning Basic Formatting How to make Links in WikiDoc & to External Sites How to Make Lists How to Ignoring Formatting Adding References or Footnotes to Articles Tracking Changes You Have Made How to Put an Article Into a Category When Multiple Topics Should Go To The Same Page (MI, Acute MI, AMI) Using Redirection Advanced editing How to Make Tables How to Insert Images and Other Media How to Add Video Help:How to Make Columns Web Colors How To Make Templates How to Move Pages Inserting Dynamic Dates and Times Inserting WikiDoc Statistics Editing the Table of Contents Communicating your edits Let others know what you changed: The importance of Edit Summaries Minor Edits Edit Conflicts Help Videos You Can Watch Getting Started Video