Acidosis and Alkalosis

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Also known as: Acid-Base Disorders
What are they? Acidosis and alkalosis are terms used to describe the abnormal conditions that result from an excess of acid or alkali (base) within the blood. Normal blood pH must be maintained within a narrow range of 7.35-7.45 to ensure the proper functioning of metabolic processes and the delivery of the right amount of oxygen to tissues. Acidosis refers to an excess of acid in the blood that causes the pH to fall below 7.35, and alkalosis refers to an excess of base in the blood that causes the pH to rise above 7.45. Many conditions and diseases can interfere with pH control in the body and cause a person's blood pH to fall outside of healthy limits.

Metabolism generates large quantities of acids that must be neutralized and/or eliminated to maintain pH balance.
Most of the acid is carbonic acid, which is created from carbon dioxide (CO2) and water. Lesser quantities of lactic acid, ketoacids, and other organic acids are also produced. The major organs involved in regulating blood pH are the lungs and the kidneys. The lungs flush acid out of the body by exhaling CO2. Raising and lowering the respiratory rate alters the amount of CO2 that is breathed out, and this can affect blood pH within seconds to minutes. The kidneys excrete acids in the urine, and they regulate the concentration of bicarbonate (HCO3-, a base) in blood. Acid-base changes due to increases or decreases in HCO3concentration occur more slowly than changes in CO2, taking hours or days. Both of these processes are always at work, and they keep the blood pH in healthy people tightly controlled. Buffering systems that resist changes in pH also contribute to the regulation of acid and base concentrations. The main buffers in blood are hemoglobin (in red blood cells), plasma proteins, bicarbonate, and phosphates. The absolute quantities of acids or bases are less important than the balance between the two and its effect on blood pH (see Figure 1, below). Acidosis occurs when blood pH falls below 7.35. It can be due to increased acid production within the body, consumption of substances that are metabolized to acids, decreased acid excretion, or increased excretion of base. Alkalosis occurs when blood pH rises above 7.45. It can be due to electrolyte disturbances caused by, for example, prolonged vomiting or severe dehydration, administration or consumption of base, and hyperventilation (with increased excretion of acid in the form of CO2). Any disease or condition that affects the lungs, kidneys, metabolism or breathing has the potential to cause acidosis or alkalosis. The normal balance between acid and base can be visualized in Figure 1.

Metabolic acid-base disorders may be due to kidney disease.g. and diseases that affect normal metabolism (e. Also known as: Acid-Base Disorders Symptoms . y Disorders that affect HCO3.concentration are called metabolic acidosis (low pH) and metabolic alkalosis (high pH)..Figure 1: Faucets and Drains Important points: The blood's pH is normally between 7. y y y y Imbalances lead to acidosis (acid sink overflow) or alkalosis (base sink overflow). Acid-base disorders are divided into two broad categories: Those that affect respiration and cause changes in CO2 concentration are called respiratory acidosis (low pH) and respiratory alkalosis (high pH). severe vomiting or diarrhea.45. ingestion of certain drugs and toxins. The body's goal is a constant balance between incoming/produced acids and bases (faucet on) and eliminated acids and bases (drain open). electrolyte disturbances. diabetes).35 and 7. Respiratory acid-base disorders are commonly due to lung y diseases or conditions that affect normal breathing. Balance can be restored by increasing elimination (faster draining) and/or by decreasing flow (slowing down drippy faucet).

Common causes of acid-bases disorders Respiratory acidosis Reduced CO2 elimination Decreased breathing rate (respiratory drive) due to drugs or central nervous system disorders Impaired breathing and lung movement (respiratory mechanics) due. infection (meningitis. and headaches. Symptoms of alkalosis are often due to associated potassium (K ) loss and may include irritability.Acidosis may not cause any symptoms or it may be associated with nonspecific symptoms such as fatigue. coma. for example. Acute acidosis may also cause an increased rate and depth of breathing. weakness. shock Drugs (aspirin) Pneumonia. pain. amyotrophic lateral sclerosis (ALS). and in some cases death. and cramping. fever Central nervous system tumor. confusion. due to loss or to increased acid Alcoholic ketoacidosis Diabetic ketoacidosis Kidney failure Lactic acidosis - y y y y . or embolism Exercise. pulmonary (lung) congestion. trauma. encephalitis) Liver failure y y y y y y Metabolic acidosis Decreased HCO3 . and vomiting. nausea. botulism. Guillain-Barre syndrome) y y Airway obstruction (food or foreign object) Lung disease Respiratory alkalosis Increased CO2 elimination Hyperventilation due to anxiety. to trauma or abnormal presence of air between the lung and the wall of the chest (pneumothorax) + y y y Respiratory muscle/nerve disease (myasthenia gravis. and it can lead to seizures.

such as from prolonged diarrhea Metabolic alkalosis Increased HCO3 . ethylene glycol Gastrointestinal bicarbonate loss.y y Toxins ± overdose of salicylates (aspirin). ingestion of alkali - y y y y . methanol. due to loss of acid or gain of bicarbonate Diuretics Prolonged vomiting Severe dehydration Administration of bicarbonate.

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