Acidosis: main causes, symptoms and treatment. Acidosis: what it is, symptoms and treatment of acidosis in adults Brain acidosis

The acid-base balance () plays an important role for the normal functioning of the body. From the point of view of applied diagnostics, changes in the concentration of hydrogen in the blood in medical practice are summarized very briefly. The blood that circulates in the body is a mixture of living cells in a liquid medium. Normally, a person's acid-base balance ranges from 7.37 to 7.44. If the value is reduced or increased by 0.1, this leads to a malfunction of the respiratory system and blood circulation. In such cases, they speak of the presence of conditions such as. Today we will find out what they are and how they manifest themselves.

Description

Acidosis is usually called an increase in the acidic environment in the blood and tissues of the body compared to the norm, while the pH decreases. If the shift occurs by 0.3, acidotic coma develops, and by 0.4, death occurs. If a person refuses to eat, so-called internal nutrition begins to occur using secondary tissues and fats. When the latter are broken down, acetone and oil products are formed. They are not excreted from the body, therefore the internal environment changes in an acidic direction.

After a while, acidosis reaches maximum levels, ketone cells are converted into amino acids, and an acidotic crisis occurs. Alkalosis is considered to be an increase in alkaline substances in the body with an increase in pH value. If the shift occurs by 0.2, the functioning of all body systems occurs. This process is called uncompensated alkalosis. With compensated alkalosis, the pH is within normal limits (7.35-7.45), but deviations appear in the buffer systems.

Kinds

Alkalosis and acidosis may occur due to diseases of the body or certain extreme conditions. Buffer systems fail to maintain the desired pH level, so either acids or alkalis accumulate. Both types of balance fluctuations have their own variations, which depend on what caused the change in balance. Some lung diseases cause changes in the concentration of carbon dioxide in the blood.

Changes in acid-base balance due to disturbances in pulmonary ventilation are called respiratory or gas alkalosis and acidosis. In diseases that affect metabolism, non-volatile acids accumulate in the blood. When vomiting, their number decreases. Non-respiratory alkalosis and acidosis are changes that are not related to respiratory function. These processes are called metabolic. Let's consider all these manifestations in more detail.

Types of acidosis

The following types of acidosis are distinguished:

1. Exogenous - appears as a result of eating components with high acidity, medications that can lower the pH level.
2. Respiratory acidosis. The rate of ventilation of the lungs decreases with respiratory disease, use of barbiturates, inhalation of air with a high percentage of carbon dioxide, etc.
3. Metabolic - observed with a large amount of non-volatile acid and a lack of ions in the liquid that is between the cells. This may be caused by poor circulation, tissue starvation, diabetes mellitus, gastrointestinal disorder, etc.
4. Excretory or renal acidosis - manifests itself in the difficulty of removing non-volatile acids by the kidneys or a large loss of alkali during vomiting.
5. Mixed - a combination of different types of acidosis.

Lactic acidosis

This pathology is accompanied by the accumulation of large amounts of lactic acid in the blood. The disease is of two types: A and B. In the first type, oxygen is completely absent in the tissues, in the second case this is not observed. This disease is inherent in those who have shortening of the small intestine. In this case, bacteria produce not only enzymes and lactic acid, which causes the development of acidosis, which can lead to coma. Lactic acidosis can be caused by leukemia, lymphoma, myeloma, epilepsy, bacteremia, exposure to toxins, and medications.

Types of alkalosis

The following types of alkalosis are distinguished:

1. Exogenous occurs as a result of the entry into the blood of drugs or substances that increase pH.
2. Respiratory alkalosis occurs with increased ventilation of the lungs, which leads to the excretion of large amounts of carbon dioxide. This is observed with brain damage, exposure to toxins and large blood loss.
3. Excretory occurs when gastric juice is lost due to the formation of fistulas in the stomach, incessant vomiting, and in diseases of the kidneys and endocrine system.
4. Metabolic alkalosis occurs when electrolyte metabolism is disrupted. Often observed after operations, in people suffering from rickets.
5. Mixed manifests itself in a combination of several types of alkalosis. Occurs with hypoxia, vomiting, and brain injuries.

Causes

Alkalosis and acidosis may arise due to various reasons, depending on their type. Acidosis appears in diseases that are accompanied by a feverish state, since organic acids are retained in the body. Acetone and acetoacetic acid appear in the urine. In severe cases, coma occurs. Acidity levels out during fasting. The causes of alkalosis lie in metabolic disorders in the body and blood infusion. The appearance of the disease can be observed as a result of consuming a high dose of sodium bicarbonate during long-term treatment of a certain disease.

The same type of food and a poor diet, dehydration, and elevated ambient temperatures can also provoke alkalosis. With brain injuries, when vomiting and hypercapnia appear, this pathology also develops. M metabolic alkalosis occurs when the body loses hydrogen ions through excessive vomiting or taking medications that increase diuresis, or prolonged intake of mineral water.

Symptoms of alkalosis

With this disorder, a decrease in cerebral blood flow and blood pressure is observed. Nervous and muscle excitability increases, convulsions may develop, and constipation is also observed. Respiratory alkalosis provokes a decrease in mental performance, dizziness and fainting occur, and the activity of the respiratory center decreases. The skin becomes pale, hysterical shortness of breath, tachycardia, and low pulse appear. If a person has previously had epileptic readiness or central nervous system damage, he may develop a seizure. If a person has hepatitis, alkalosis may not show symptoms.

Symptoms may also include weakness, thirst, lack of appetite, drowsiness, and mental retardation. If help is not provided in time, coma may occur. With metabolic alkalosis, edema may appear, Burnet's syndrome develops, in which apathy, aversion to dairy products, skin itching, conjunctivitis, renal failure develop, and polyuria or polydipsia develops.

Symptoms of acidosis

This type of disorder provokes lethargy, rapid breathing, a state of stupor and stupor, which can result in shock and death. Sometimes the patient experiences nausea, vomiting, and hyperpnea. With acidosis, there is a high risk of arrhythmia, a decrease in pressure is observed, which can result in disturbances in metabolic processes in the brain.

Also acidosis, symptoms and treatment which we are considering, can provoke dehydration and the formation of heart disease. In its acute form, the disease manifests itself as indigestion, circulatory disorders, and general lethargy.

Diagnostics

Diagnosis is easy. To do this, urine is tested for pH and blood to determine its gas and electrolyte composition. The diagnosis of alkalosis is based on the patient’s clinical data and determines the presence of chloride in the urine. To detect acidosis, a test using ammonium or calcium chloride is used, and blood and plasma are examined for gas composition and electrolyte levels.

Treatment of acidosis

If the acidosis is moderate, no specific treatment is prescribed. They only recommend sticking to a diet, excluding protein foods from the diet. In other forms, patients are given intravenous saline solutions and potassium chloride is prescribed. If a patient has adrenal hyperfunction, the underlying disease is treated. In the presence of Barter's syndrome, prostaglandin synthetase inhibitors are used.

Therapy is mainly aimed at preventing the development of anemia, hypovolemia, and correcting the respiratory process. For this, alkali solutions are used. Acidosis is treated with drugs such as Trisamine, Nicotinic acid, Riboflavin, Carnitine, Lipoic acid, and so on. It is also necessary to properly organize your diet and consume foods that help remove toxins from the body.

Treatment of alkalosis

Therapy in this case should be comprehensive. Treatment should help eliminate the causes of the pathology. Thus, gas alkalosis is treated with mixtures containing carbon dioxide, the patient is given inhalations and Seduxen is prescribed. Non-gas alkaloses are treated depending on their type. Usually they use ammonium, insulin, etc. For metabolic alkalosis, intravenous calcium chloride, glucose and insulin are prescribed. The patient is prescribed drugs such as Spironolactone, Panangin, and Ammonium Chloride.

In addition to specific treatment for pathologies such as, therapy is prescribed aimed at eliminating concomitant ailments that caused the appearance of pathologies.

Prevention

First of all, the patient needs to establish a lifestyle, observing sleep and diet. Bad habits should be eliminated; it is recommended to eat fruits and vegetables. This all contributes to the prevention of pathologies such as alkalosis and acidosis. But proper nutrition alone is not enough; moderate physical activity is needed. It is also worth paying attention to the presence of other diseases and treating them in a timely manner so that they do not provoke a change in the acid-base balance of the blood.

Doctors recommend undergoing a medical examination once a year for the purpose of prevention. To balance BER, you need to know that mineral water and milk increase the level of alkalis, while tea and coffee, sweets and meat increase the level of acids. Therefore, such products should be consumed in moderation. Properly coordinated preventive measures help maintain acid-base balance in the body, so a person will feel good.

The body and pH

We already know the concept of acidosis and alkalosis. But can the body protect itself from an imbalance of acids and alkalis in the blood? The human body has super-efficient mechanisms that monitor pH levels. These mechanisms include the buffer and respiratory systems, as well as the kidneys. The buffer system is able to instantly return the pH level to normal because it is able to absorb and release hydrogen ions in case of deficiency or excess.

The respiratory system works through the respiratory brain centers, which are able to speed up or slow down breathing depending on the concentration of carbon dioxide in the blood. The kidneys are able to maintain the balance of acids and alkalis by absorbing, retaining and excreting them. All these mechanisms are independent of environmental influences, but in some human diseases they fail.

Thus, every chemical reaction that occurs in the human body is affected by the accumulation of hydrogen ions in it. The more it is in the blood, the lower the pH level, and the less it is, the higher the pH becomes. For the body to function properly, the accumulation of hydrogen ions must be within normal limits, since small fluctuations can negatively affect health. With a high dose of hydrogen ions, the blood becomes very acidic, and with a low level of hydrogen ions, the blood will be quite alkaline. All this can lead to various malfunctions in the body that require therapy.

• What is Acidosis
• What causes acidosis
• Symptoms of Acidosis
• Diagnosis of Acidosis
• Treatment of Acidosis

What is Acidosis

Acidosis(from Latin acidus - sour), a change in the acid-base balance of the body as a result of insufficient excretion and oxidation of organic acids (for example, betahydroxybutyric acid). Typically, these products are quickly eliminated from the body. In case of febrile diseases, intestinal disorders, pregnancy, fasting, etc., they are retained in the body, which is manifested in mild cases by the appearance of acetoacetic acid and acetone in the urine (the so-called acetonuria), and in severe cases (for example, with diabetes) can lead to to a coma.

What causes acidosis

Typically, the oxidation products of organic acids are quickly removed from the body. In case of febrile diseases, intestinal disorders, pregnancy, fasting, etc., they are retained in the body, which is manifested in mild cases by the appearance of acetoacetic acid and acetone in the urine (the so-called. acetonuria), and in severe cases (for example, with diabetes) it can lead to coma.

Pathogenesis (what happens?) during Acidosis

According to the mechanisms of occurrence, there are 4 types of acid-base disorders, each of which can be compensated or decompensated:

1. non-respiratory (metabolic) acidosis;
2. respiratory acidosis;
3. non-respiratory (metabolic) alkalosis;
4. respiratory alkalosis.

Non-respiratory (metabolic) acidosis- This is the most common and most severe form of acid-base imbalance. Non-respiratory (metabolic) acidosis is based on the accumulation in the blood of so-called non-volatile acids (lactic acid, hydroxybutyric acid, acetoacetic acid, etc.) or the loss of buffer bases by the body.

Symptoms of Acidosis

The main symptoms of acidosis are often masked by the manifestations of the underlying disease or are difficult to distinguish from them. Mild acidosis may be asymptomatic or accompanied by some fatigue, nausea, and vomiting. For severe metabolic acidosis (for example, pH less than 7.2 and bicarbonate ion concentration less than 10 mEq/L), hyperpnea is most characteristic, manifested by an increase first in the depth and then in the frequency of respiration (Kussmaul respiration). Signs of decreased ECF volume may also be observed, especially with diabetic acidosis or loss of bases through the gastrointestinal tract. Severe acidosis sometimes leads to circulatory shock due to impaired myocardial contractility and the response of peripheral vessels to catecholamines, as well as increasing stupor.

Diagnosis of Acidosis

In severe acidosis, when the content of bicarbonate ions in the plasma becomes very low, the urine pH drops below 5.5, the blood pH below 7.35, and the HCO3 concentration below 21 mEq/L. In the absence of pulmonary diseases, the partial pressure of carbon dioxide in arterial blood does not reach 40 mmHg. Art. With simple metabolic acidosis, it can decrease by about 1-1.3 mm Hg. Art. for every mEq/L decrease in plasma HCO3 levels. A greater drop in paCO2 indicates simultaneous primary respiratory alkalosis.

Many forms of metabolic acidosis are characterized by increase in undetectable anions. The amount of serum undetectable anions (sometimes called anion gap or anion deficiency) is estimated by the difference between the serum sodium concentration and the sum of the chloride and bicarbonate concentrations. It is believed that normally this value ranges between 12 + 4 meq/l. However, it is derived from measuring electrolyte levels using a Technicon auto analyzer, which was widely used in the 1970s. Currently, most clinical laboratories use other methods that give slightly different figures. In particular, the normal serum chloride level is higher, and there are normally fewer undetectable anions - only 3-6 mEq/L. You should be aware of this and proceed from the limits of the standards established in the laboratory whose services are used in this particular case.

Metabolic acidosis may be associated with the accumulation of undetectable anions - for example, sulfate in renal failure, ketone bodies in diabetic or alcoholic ketoacidosis, lactate or exogenous toxic substances (ethylene glycol, salicylates). Metabolic acidosis with normal amounts of undetectable anions (hyperchloremic metabolic acidosis) is usually due to primary loss of bicarbonate through the gastrointestinal tract or kidneys (eg, renal tubular acidosis).

Diabetic acidosis usually characterized by hyperglycemia and ketonemia. With hyperglycemia and non-ketone (according to routine clinical tests) acidosis, the content of lactic and/or p-hydroxybutyric acid in the blood is increased.

Ethylene glycol poisoning should be suspected in unexplained acidosis if oxalate crystals are present in the urine.

Salicylate poisoning characterized first by respiratory alkalosis and then by metabolic acidosis; the level of salicylates in the blood usually exceeds 30-40 mg%.

Since acidosis is often accompanied by hypovolemia, mild azotemia is often observed (blood urea nitrogen content 30-60 mg%). Greater increases in blood urea nitrogen, especially when combined with hypocalcemia and hyperphosphatemia, suggest renal failure as the cause of acidosis. Hypocalcemia is sometimes observed in septic shock. Changes in serum potassium levels during acidosis are discussed above (see disorders of potassium metabolism). In lactic acidosis, hyperkalemia is relatively rare unless there is concurrent renal failure and/or increased tissue breakdown.

Treatment of Acidosis

Elimination of the cause that caused acidosis (for example, lack of insulin in diabetes), as well as symptomatic - ingestion of soda, drinking plenty of fluids.

Which doctors should you contact if you have Acidosis?

Therapist

Reanimatologist

Emergency doctor

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For normal functioning of the body, it is necessary to maintain all its functions in a state of balance. This concerns not only the level of hormones, the activity of the sympathetic and parasympathetic nervous systems, but also the acid-base composition of the blood. Normally, the amounts of substances with low and high acidity (abbreviated as pH) are in a certain balance. Due to this, the blood has a slightly alkaline environment. When the concentration of alkalis increases, a person develops “alkalosis”; when the concentration of acids increases, a person develops “acidosis”.

Metabolic acidosis develops in various diseases that are not associated with damage to the respiratory system. It cannot occur on its own and is always a complication of some other disease. You can get all the necessary information about the causes, symptoms and treatment methods of this condition from this article.

Why is acidosis dangerous?

This is a serious complication that can occur due to severe infections, diabetes, impaired liver function, kidney function, and a number of other pathologies. “Acidification” of the blood causes a number of additional disturbances in the functioning of organs and tissues, among which the most dangerous are:

• Damage to cells throughout the body. A large amount of free acids corrodes the outer membrane of cells, which leads to disruption of their functions. Since toxins are distributed to all organs and tissues, pathological changes can be very diverse;
• Respiratory disorders. Oxygen in the body is alkali in its chemical role. Therefore, patients are characterized by deep, frequent breathing - this is how the body tries to reduce acidity. Unfortunately, this process leads to narrowing of cerebral blood vessels and increased blood pressure. As a result, the person’s condition only worsens and increases the risk of hemorrhages in various organs;
• Increased blood pressure. The mechanism of occurrence is associated with the presence of breathing disorders;
• Damage to the digestive organs. In most patients, acute metabolic acidosis causes abdominal pain, stool disorders and other dyspeptic symptoms. With this disorder, aggressive substances such as acetone and hydroxybutyric acid are often formed, which corrode the mucous membrane of the stomach, esophagus and intestines. In some cases, patients even experience bleeding from these organs;
• Depression of consciousness. Toxins produced by the body negatively affect the nerves and brain matter. In mild cases, the patient may experience irritability, weakness, drowsiness, and in severe cases, coma;
• Heart dysfunction. Damage to cells and nervous tissue, imbalance of microelements and a number of other factors inevitably affect the myocardium. In the first stages, this effect can manifest itself as frequent and strong heartbeats and rhythm disturbances. In severe cases of pathology, heart contractions weaken and become more rare. The final stage is cardiac arrest.

All of these disorders can not only worsen your health, but also pose a threat to life. That is why the first signs of the disease must be detected and treated as early as possible.

Types of metabolic acidosis

Diagnosing a specific form of pathology is very important - this allows not only to find out the cause of its development, but also to determine the optimal medical tactics. At the moment, doctors use 2 main classifications that help make a diagnosis.

The first reflects the connection with diabetes. It is necessary to determine whether the patient has this disease before starting treatment, since metabolic acidosis in diabetes mellitus has its own characteristics. Its therapy necessarily includes correction of glucose (sugar) levels. Without this nuance, any other treatment procedures will be ineffective.

The criterion for the second classification is the type of poisoning of the body. Various acids can increase in human blood, the most dangerous of which are lactic acid and ketone bodies (acetone, butyric acids). Depending on the “acidifying” substance, the following are distinguished:

1. Ketoacidosis. The presence of hydroxybutyric acids and acetone is noted in the patient’s blood. Often develops against the background of diabetes, but can also occur with other diseases;
2. Lactic acidosis. Accompanied by an increase in the concentration of lactic acid. It can occur with a large number of diseases, including due to dysfunction of the liver or kidneys, the development of a severe infection, poisoning, etc.;
3. Combined form. It often occurs in people with high sugar levels and in the presence of provoking factors. The latter may include severe stress, physical overload, infectious diseases and a number of other conditions.

The reasons for the occurrence of various forms are somewhat different from each other. They need to be known in order to quickly guess the type of disease and correctly treat metabolic acidosis.

Causes

As mentioned above, this pathology does not occur on its own. This is always a consequence of another disease, which leads to metabolic disorders and the accumulation of toxins. The mechanisms and causes of metabolic acidosis differ in different forms. All the necessary information on this issue is presented in the table below.

Some doctors additionally identify the hyperchloremic form, which occurs in conjunction with lactic acidosis. However, according to information from modern scientific publications, chlorine metabolism disorders are a less significant condition. They have virtually no effect on treatment tactics, so now they are not distinguished as a separate type.

Symptoms

This condition does not have any characteristic signs. A change in acidity is accompanied by a large number of different symptoms, which can be quite difficult to associate with each other. This is why it is quite difficult to identify the disease at home.

Common manifestations that can be observed with any form of the disease include:

• Constant nausea with vomiting, after which there is no improvement in well-being;
• Severe weakness that forces the patient to stay in bed;
• The appearance of shortness of breath at rest. A person cannot “breathe”, which is why his breathing becomes frequent and deep;
• Paleness of the skin and visible mucous membranes (eyes, mouth and nasal cavity);
• The appearance of cold sweat on the skin;
• Slows the heartbeat and lowers blood pressure;
• The development of convulsions, severe dizziness and loss of consciousness (even coma) is possible.

As we have already said, a change in acidity does not happen on its own. This condition is always preceded by some other disease. To put it simply, we can say that a sharp deterioration in well-being due to the disease is often the first symptom. In this case, it is necessary to call an ambulance team, which will assess the situation and, if necessary, hospitalize the patient. In the hospital, doctors will establish a final diagnosis, conduct the necessary studies and treatment measures.

Diagnostics

Conventionally, all studies are carried out with three goals: to assess the level of blood acidity, to determine the type of pathology and to find out the causes of the pathology. For the first goal, it is enough to conduct one study - determining the acid-base state. To find out the cause of pH changes, significantly more diagnostic measures may be required.

Acid-base blood test

The simplest and most reliable way to confirm the presence of metabolic acidosis is to perform this test. This does not require any special preparation from the patient. As needed, blood is taken from a vein from the patient and sent to the laboratory. As a rule, the finished result can be obtained within a few hours.

To decipher the results, it is necessary to know the normal values ​​of the indicators and their deviations in the disease. This information is presented in the table below:

This analysis is sufficient to confirm the presence of pathology. However, to clarify its form and the reasons for its development, a number of additional studies are necessary.

Determining the type of pathology

For this purpose, doctors prescribe the patient a general urine test and a biochemical blood test, which necessarily includes determining the level of glucose and lactic acid. These two tests can quickly determine the specific type of acid-base disorder.

Determining the cause

To find out the cause, doctors may order a large number of different tests, depending on their assumptions. However, there are tests that are mandatory for all patients with this disease. They allow you to assess the condition of the main organs and systems at the lowest cost. This "diagnostic minimum" includes:

In addition to these laboratory diagnostic methods, doctors may recommend ultrasound, magnetic resonance or computed tomography, scintigraphy of individual organs and a number of other procedures. The decision on the required amount of research is determined individually, depending on the suspected cause of the decrease in acidity.

Principles of treatment

Correcting metabolic acidosis is quite a difficult task even for an experienced doctor. Each patient suspected of having this disease is asked to be hospitalized, as they need constant monitoring, regular intravenous infusions of solutions and periodic examinations.

All treatment goals can be divided into two groups - restoration of normal blood acidity and elimination of the cause of the pathology.

pH restoration

First of all, doctors are trying to find out what disease led to the development of the pathology. If it is diabetes, therapy to lower glucose levels with insulin and medications begins immediately. If a severe infection develops, complex treatment is carried out using antibacterial/antiviral drugs. If a decrease in pH has caused severe damage to an organ, the attending physician tries to restore its function or replace it with the help of medications and instrumental techniques (for example, hemodialysis).

Simultaneously with the measures listed above, infusion therapy is required - drip intravenous infusion of solutions. The choice of solution depends on the type:

Infusion therapy in children is carried out according to the same principles as in adults. The main thing is to correctly determine the cause and variant of the disease. The only difference is the volume of intravenous infusions - the child requires significantly less fluids. Doctors calculate the required amount based on body weight.

Features of therapy for individual forms

Since each form has different pathological mechanisms, some aspects of their treatment differ from each other. In this section we present the most important principles that must be followed when prescribing therapy:

1. For lactic acidosis, in addition to infusion therapy, B vitamins (thiamine, pyridoxine, cyanocobalamin) must be prescribed every 12 hours. These substances improve metabolism and help normalize acidity. To combat the lack of air, patients are given continuous oxygen inhalation through a mask or nasal prongs. In case of severe acidosis, when the level of lactic acid increases 4-5 times, doctors can “cleanse” the blood - hemodialysis;
2. In case of ketoacidosis without diabetes, it is recommended to prescribe drugs that restore the functioning of the digestive system (Domperidone, Metoclopramide) as an addition to standard therapy. This will reduce fluid loss through vomiting and improve food digestion. Feeding must be done orally (using a gastric tube or frequent split feedings). It should be high in calories, high in carbohydrates and low in fat. Vitamin therapy is also indicated for patients;
3. For diabetic ketoacidosis, the main treatment is insulin administration. Reducing sugar concentrations and sufficient intravenous infusions are the most effective methods of therapy. After these measures, in most cases, the pH is restored to normal values ​​and the patient’s well-being improves.

Treatment of a child is carried out according to the same principles as therapy for an adult patient. However, it should be remembered that children are more susceptible to any disease, especially those accompanied by changes in acidity. Therefore, timely hospitalization and properly provided medical care are especially important for them.

FAQ

It depends on the cause of the disease. If the patient has diabetes, he is prescribed a table without easily digestible carbohydrates and with a predominant amount of protein foods. When glucose levels are low (due to non-diabetic ketoacidosis), on the contrary, carbohydrates should become the main component of food to compensate for the lack of energy.

Question:
How long will it take to treat this disease?

Depends on the severity of the disease and the condition of the patient. The minimum duration of therapy, in most cases, is 2 weeks.

Question:
What are the most common causes of acidosis in newborns?

In the vast majority of cases, this condition develops as a result of various intrauterine pathologies, which lead to oxygen starvation of the child and disrupt the flow of nutrients through the placenta. The cause may be premature placental abruption, post-term pregnancy, premature birth, umbilical cord pathologies, etc. In this case, both ketoacidosis and lactate accumulation can occur. Treatment of such children is carried out according to the same principles as described above.

Question:
Is it possible to develop complications after an illness?

Decreased blood pH itself can cause severe damage to the brain, heart, or kidneys. It should also be remembered that the disease that causes it can lead to damage to other organs.

Question:
Are there different symptoms of ketoacidosis and lactic acidosis?

Of the characteristic signs, two should be noted: the appearance of the smell of acetone and the speed of development of coma. The appearance of a specific odor from the patient’s skin is characteristic only of ketoacidosis, while a patient with a disorder of lactic acid metabolism smells normally. Based on the time of development of coma, one can also assume a variant of the disease - with lactic acidosis, most often, disturbances of consciousness occur quickly (within several hours). While in a patient with a high level of ketone bodies in the blood, consciousness can remain for 12-20 hours.

Metabolic acidosis is a pathological condition characterized by an imbalance in the acid-base balance in the blood. The disease develops against the background of poor oxidation of organic acids or their insufficient removal from the human body.

The sources of this disorder are a large number of unfavorable factors, ranging from many years of addiction to drinking alcoholic beverages and ending with the presence of oncology of any localization.

Symptoms directly depend on the disease that provoked it. The most common external manifestations are considered to be rapid breathing, lethargy, constant drowsiness and confusion.

The basis of diagnosis is the indicators of laboratory tests. However, instrumental procedures and primary diagnostic measures may be required to determine the cause.

Treatment of metabolic acidosis is aimed at restoring pH. This is achieved by taking medications, following a gentle diet and eliminating the underlying disease.

Etiology

It must be taken into account that such a disorder in all cases acts as a consequence of another disease, which means that it should be considered not as a separate disease, but as a clinical manifestation.

Thus, metabolic acidosis has the following causes:

• malignant neoplasms, regardless of their location;
• acute or chronic;
• decreased blood glucose levels;
• states of shock;
• heavy;
• prolonged oxygen starvation of the body;
• the occurrence of kidney pathologies;
• strongest;
• diseases accompanied by convulsive seizures;
• or lack of adequate therapy;
• or ;
• severe injuries;
• previous surgical intervention;
• infectious pathologies of a purulent nature;
• disruption of intestinal function;
• Budd-Chiari syndrome;
• disruption of the circulatory process;
• cyclic vomiting syndrome;
• fever.

At the same time, acid-base balance indicators may change against the background of:

• the period of bearing a child;
• long-term alcohol abuse;
• following excessively strict diets or prolonged refusal to eat;
• prolonged exposure to stressful situations;
• heavy physical activity.

In addition, drug overdose is considered to be a predisposing factor, namely:

• "Diphenhydramine";
• sweeteners;
• medicines containing iron;
• Sodium nitroprusside;
• salicylates;
• "Aspirin".

Also, the likelihood of developing such a disease increases significantly when leading a sedentary lifestyle and poor nutrition.

The pathogenesis of metabolic acidosis lies in the fact that a large number of metabolic products of acid origin are produced in conjunction with impaired functioning of the kidneys, due to which they cannot remove toxins from the body.

Classification

Clinicians distinguish several degrees of severity of this pathological condition:

• compensated metabolic acidosis – with a pH value of 7.35;
• subcompensated type - indicators vary from 7.25 to 7.34;
• decompensated type – the level drops to 7.25 and below.

Based on the above etiological factors, there are the following forms of the described disorder:

• diabetic ketoacidosis is a condition that develops against the background of controlled diabetes mellitus;
• non-diabetic ketoacidosis – formed against the background of other unfavorable underlying causes;
• hyperchloremic acidosis - is a consequence of insufficient sodium bicarbonate or excessive loss of such a substance through the kidneys;
• Lactic acidosis – characterized by the accumulation of large amounts of lactic acid.

The latter type, in turn, has several varieties:

• form A – characterized by the most severe course;
• form B;
• unusual D shape.

In addition, it is customary to distinguish:

• high anion gap acidosis;
• acidosis with normal anion gap.

In the vast majority of cases, acute metabolic acidosis occurs, but sometimes it becomes chronic, and then it can occur with hidden symptoms.

Symptoms

The symptoms of metabolic acidosis directly depend on the disease that provoked the onset of the pathology.

The main manifestations are:

• increased breathing;
• constant nausea and vomiting, which does not improve the general condition of a person;
• shortness of breath that occurs even at rest;
• extreme weakness;
• painful pallor of the skin and visible mucous membranes;
• slow heart rate;
• decreased blood tone values;
• dizziness;
• lethargy;
• attacks of loss of consciousness;
• seizures;
• drowsiness;
• feeling of lack of air;
• smell of acetone from the mouth;
• shock or coma.

It should be noted that in some cases external manifestations may be completely absent.

If the following symptoms occur, it is necessary to take the patient to a medical facility as soon as possible or call an ambulance at home:

• deep and frequent breathing;
• severe weakness - to such an extent that the victim cannot get out of bed;
• fainting;
• confusion.

In such situations, all diagnostic and therapeutic measures are carried out in intensive care conditions.

Diagnostics

The main measures to make a diagnosis of metabolic acidosis are laboratory tests. However, the diagnostic process must take an integrated approach, which is determined by the need to find the cause of the formation of such a problem.

Primary diagnosis includes:

• study of medical history;
• collection and analysis of life history to identify the influence of predisposing factors not related to the course of a particular disease;
• assessment of the condition of the skin and visible mucous membranes;
• measuring blood pressure, heart rate and body temperature;
• a detailed survey of the patient - for the doctor to compile a complete symptomatic picture, which will also help to identify the provoking disease.

Among the laboratory tests it is worth highlighting:

• general clinical analysis and blood biochemistry;
• general urine analysis;
• whole plasma base assessment (bb);
• serum study.

General instrumental procedures, for example, ultrasound and radiography, CT and MRI, ECG and biopsy are necessary to detect malignant tumors, as well as to determine whether there is damage to the liver, kidneys or other internal organs.

Treatment

Correction of metabolic acidosis is carried out only by conservative, therapeutic methods.

Drug treatment is aimed at using:

• preparations containing electrolytes and sodium bicarbonate;
• solutions with anti-ketone action;
• B vitamins;
• substances that normalize the functioning of the digestive system.

Most often patients are prescribed:

• "Sterofundin";
• "Trisol";
• "Disol";
• "Thiamin";
• "Domperidone";
• "Ringer's solution";
• "Xylate";
• "Pyridoxine";
• "Reosorbilact";
• "Cyanocobalamin";
• "Metroclopramide".

In addition, compensation for metabolic acidosis should include:

• hemodialysis;
• oxygen inhalations;
• intravenous administration of glucose is prohibited only for diabetes mellitus;
• maintaining a gentle diet - a diet is necessary to reduce fluid loss with excessive vomiting or diarrhea, as well as to improve the digestion of food.

The menu should be high in calories, high in carbohydrates and limited in fat intake.

Without eliminating the underlying negative source, it is impossible to completely get rid of such pathology. Treatment of the provoking disease can be conservative, surgical or combined.

Prevention and prognosis

You can prevent the formation of such a disease by following certain preventive recommendations, including:

• complete cessation of bad habits;
• balanced diet;
• taking medications as prescribed by the attending physician;
• constant monitoring of blood glucose levels, this is especially necessary for people with diabetes;
• maintaining a moderately active lifestyle;
• avoiding the influence of stressful situations;
• timely diagnosis and comprehensive treatment of ailments that can lead to the described disorder.

In addition, it is mandatory to undergo a full examination several times a year at a medical institution, visiting all specialists and performing appropriate laboratory and instrumental procedures, in particular, a general blood test. We must always remember that it is easier to prevent a disease than to cure it, and for this we must follow preventive recommendations.

Metabolic acidosis has an ambiguous prognosis. This is due to the fact that it completely depends on the underlying disease, the severity of its course and the time of initiation of treatment.

The main complications of this disorder are coma and death.

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One of the most significant indicators of human health can be considered acid-base balance. It is quite normal that during functioning in the body many acids are formed, which are then almost immediately excreted through sweat, urine or through the lungs. If this balance is disturbed, acidosis may occur - a phenomenon characterized by the accumulation of acids in the tissues of organs, which are destroyed because of this. In many cases, this condition occurs due to a lack of minerals. Acidosis is a shift in the acid-base balance towards a decrease in the pH value of hydrogen and an increase in the acidity of its environment.

Acidosis and alkalosis

Most of all diseases that develop in the human body can greatly affect the balance of acids and the internal environment. Because of this, a condition such as acidosis (acidification) or alkalosis (alkalization) may occur. In the presence of a compensated form of acidosis and alkalosis, the absolute amount of carbonic acid changes, but their quantitative ratio is normal. Problems of the decompensated type cause changes to shift towards acids or towards bases.

Causes of acidosis

It is important to understand that acidosis is not a disease, but only a condition of the body, which is a consequence of an impaired acid-base balance. This happens due to incomplete removal and oxidation of organic acids. Usually, during normal functioning of the body, these substances are eliminated in a short time. Only in some diseases and conditions of the body this happens slowly. The main conditions in which acidosis can develop are:

• respiratory failure due to pneumonia, pathology of dilated air spaces of the distal bronchioles (pulmonary emphysema), rare shallow breathing (hypoventilation);
• for malignant tumors;
• with diets and excessive hunger strikes;
• with regular alcohol consumption;
• with low blood glucose levels (hypoglycemia);
• with renal failure;
• in experienced smokers;
• in case of poisoning, lack of appetite, problems with the gastrointestinal tract;
• during pregnancy;
• with a lack of fluid in the body (dehydration);
• poisoning with harmful chemical substances can cause acidosis;
• with heart failure, heart attack, anemia, shock (that is, during oxygen starvation);
• loss of acid salts of carbonic acid by the kidneys;
• the use of special medications (salicylates, calcium chloride, etc.) may cause acidosis;
• conditions of the body that cause impaired metabolism: diabetes mellitus, lack of blood flow, fever.

Varieties

The following types of acidosis are known today:

• non-respiratory, which is characterized by an excess amount of non-volatile acids;
• respiratory or gas, which occurs due to air entering the body during inhalation with a high concentration of carbon dioxide;
• mixed, which arises as a result of several reasons.

Non-respiratory or non-gas subspecies

1. Exogenous - the acid balance increases due to the ingestion of a large amount of substances into the body, which are converted into acids during metabolism.
2. Excretory - occurs due to impaired excretion of non-volatile acids from the body (typical for people with renal failure).
3. Acute metabolic acidosis is the most severe type of pathology, which is characterized by the accumulation of endogenous acids due to their poor destruction or binding. It can also be classified into:

• Lactic acidosis - occurs due to excess lactic acid in the body.
• Hyperchloremic - develops due to an increased amount of chlorine in the blood plasma.
• Diabetic acidosis in diabetes mellitus, as a complication of this disease, is a sign of the content of a large number of acetone bodies in the blood, as well as excess glucose in the blood serum.

Classification according to hydrogen index

The pH value plays a big role in the body. Its norm ranges from 7.25 to 7.44. If this indicator is exceeded or, on the contrary, falls, then the protein loses its natural properties, enzymes begin to function worse and cell destruction occurs. These processes can cause destruction of the body. Based on the pH level, the described state is divided into:

• compensated - the blood pH shifts towards the lower norm - 7.35 (in most cases not accompanied by any special symptoms);
• subcompensated - the acid level increases, the pH reaches 7.29-7.35 (symptoms may include shortness of breath, diarrhea, arrhythmia, vomiting);
• decompensated - the pH level drops below 7.29, and problems arise with the digestive system, heart and brain.

Clinical picture

To date, there are no clear signs of acidosis in humans that would distinguish it from other diseases. Usually, with this disorder in a mild form, it is difficult to immediately understand that the body has problems with shifting the balance. So only a professional doctor can make an accurate diagnosis. The main symptoms of acidosis are:

• nausea and short, short-term vomiting;
• fainting, loss of consciousness;
• general weakness, lethargy, fatigue;
• dizziness;
• abnormal heartbeat, heart rate, abnormal pulse;
• high blood pressure;
• dyspnea;
• feeling of deafness, stuffiness in the ears;
• drowsiness;
• inhibited reaction, stupor;
• shock, causeless anxiety;
• increase in depth and frequency of breathing.

Disease in children

Basically, the disease acidosis in children occurs due to increased fat burning due to a lack of carbohydrates. The cause may be diabetes mellitus or an unhealthy, unbalanced diet. Also, acidosis in children can be a consequence of renal failure, diarrhea, impaired absorption in the intestines, and Addison's disease. The clinical picture of childhood acidosis is as follows:

• lack of appetite;
• general malaise, lethargy, fatigue, moodiness;
• depressed state of the central nervous system;
• inhibition of reactions, stupor;
• increased breathing;
• disturbances in the functioning of the stomach;
• marbling of the skin, pallor;
• dehydration due to diarrhea and vomiting;
• increased body temperature;
• in diabetes there is a characteristic smell of rot from the mouth;
• headache.

At the first suspicion, it is necessary to diagnose acidosis in a clinical setting.

Diagnostic measures

If you notice any of the symptoms described above, which may indicate an imbalance in acid-base balance, visit your doctor immediately. Only he can diagnose a disease or pathology and prescribe proper treatment. To make a diagnosis, the following tests for acidosis may be prescribed:

• artery blood test for serum electrolytes;
• urine pH test;
• analysis of arterial blood, which is collected from the radial artery at the wrist, for gas composition.

Basically, all blood tests record not only the fact of the presence of acidosis in the body, but also its type: respiratory, metabolic, etc. In most cases, to determine the cause of the pathology, the doctor may prescribe additional diagnostics. For example, ultrasound examination and urine analysis.

Therapy

Since acidosis occurs due to impaired functioning of the body's systems and organs, the course of treatment is based on the treatment of the disease or dysfunction that led to a shift in the acid-base balance. Any type of acidosis can significantly weaken the body, so at the first suspicion of this pathology, rush to visit a specialist. Typically, treatment of complex forms of acidosis includes the following items:

• improvement of pulmonary ventilation;
• decrease in the amount of protein in the blood plasma;
• strengthening the buffer hydrocarbonate system;
• restoration of blood microcirculation, reduction of its volume;
• normalization of oxidation processes by introducing glucose, ascorbic acid, Riboxin, Pyridoxine, Thiamine, Insulin;
• elimination of the cause of pathology;
• normalization of electrolyte metabolism;
• improving blood flow in the kidneys.

To eliminate symptoms, treatment of acidosis involves the following: ingesting a certain amount of soda (sodium bicarbonate); increased drinking; elimination of additional symptoms such as arrhythmia, nausea, lethargy. If poisoning is detected, medications are prescribed to remove toxic substances from the body; in especially severe situations, it is necessary to cleanse the body. If the acidosis has not become acute, it is worth reducing the consumption of protein foods. An excellent medication is calcium carbonate.

To get rid of metabolic acidosis, glutamic and nicotinic acids, as well as cocarboxylase, are prescribed. Acute forms of acidosis must be treated with rehydration salts. Even if the acid-base balance is disturbed, take Dichloroacetate, which activates enzymes. In addition to medications, the patient should eat a balanced diet and eliminate alcohol and coffee from the diet.

On a note! When treating symptoms of acidosis, the ratio of acids and alkalis must be monitored. For this purpose, an ionogram is constantly taken during therapy.

Correct nutrition

To avoid acidosis, you should think about proper nutrition. The reason for the disturbed acid-base balance is most often the so-called one-sided diet, in which one type of food predominates in the diet: meat, dough products, confectionery. However, diet alone for acidosis is not a sufficient solution. Doctors also recommend playing sports and leading an active lifestyle. The fact is that moderate physical activity promotes excellent ventilation of the lungs, which is why the body is supplied with a large volume of oxygen. All this favors acid metabolism.

To get rid of acidosis and restore the acid-base balance, it is recommended to regularly drink plenty of fluids, still mineral water and add such products to your menu;

• not too fatty meat;
• porridge, in particular oatmeal and buckwheat;
• green tea, herbal decoctions and infusions;
• fresh vegetables, fruits and berries;
• whole grains and whole grains;
• rice broth.

During the period of treatment for this disorder, you should not “indulge” in rich broths, borscht with sauerkraut and sorrel, hot sauces, marinades and appetizers. Also reduce the amount of fast carbohydrates in your diet, since during their digestion a large amount of acids are formed. Products that you should forget about for a while include:

• potato;
• confectionery and bakery products;
• pasta;
• animal fats;
• carbonated drinks;
• sausage products, frankfurters and small sausages;
• alcoholic and alcoholic beverages;
• coffee and black tea;
• crackers and chips.

Preventive actions

In order not to encounter the problem of disturbed acid-base balance, and therefore to avoid the consequences and symptoms of acidosis, you must adhere to a number of rules. First of all, it is recommended to eat a healthy and balanced diet, take care of the quality of the products consumed, spend more time in the fresh air, engage in active sports, and also give up bad habits, in particular, the abuse of alcoholic beverages and cigarettes. Also, to prevent acidosis, doctors give the following recommendations:

• pay attention to any metabolic disorders in a timely manner in order to take therapeutic measures to prevent further consequences;
• food should consist mainly of raw products of plant origin;
• play more sports, move actively, because this promotes improved blood supply to all organs and normalizes the functioning of the respiratory system;
• drink more liquid, but do not forget about clean water, its amount should be approximately 2 liters;
• to quickly relieve the unpleasant symptoms of poisoning, you can drink a soda solution;
• Monitor the quality of drinking water and the degree of its saturation with minerals and nutrients.

As it turned out, acidosis is not a serious disease or dangerous pathology, it is just a temporary condition of the body, so there is no need to panic. But the clinical picture of a disturbed acid-base balance can be extremely unpleasant, so if you experience discomfort, you should not leave things to chance. Do not self-medicate, consult a doctor immediately. Only a specialist can make the correct diagnosis, identify the type of acidosis and prescribe competent and effective treatment accordingly.

Complications and prognosis

Acidosis is a clear symptom that a metabolic disorder occurs in the human body. The main cause can be very serious diseases.

Therefore, if the main cause of acidosis is not eliminated, then there is a risk that the amount of acids of organic origin in the blood will constantly increase. This will lead to rapid depletion of compensatory mechanisms. In especially severe cases, this phenomenon can result in a prolonged coma for a person.

If you are faced with a problem such as acidosis, then do not panic. It is important to undergo a timely examination by specialists and establish the true cause of the development of such a condition in the body. After this, it will be possible to begin treatment. If you choose the right therapy, acidosis is eliminated quickly enough without any dangerous consequences for the human body.

Take care of your diet and lead a healthy and active lifestyle. In this case, the likelihood of encountering the problem of acidosis and disturbed acid-base balance is incredibly low. In addition, the metabolism will always be normal, which will have an extremely positive effect on a person’s condition and his health. Despite the fact that this is not a completely serious disorder in the body’s functioning, it should not be taken lightly. In some cases, the consequences of acidosis can be quite serious if this pathology develops along with other diseases. Do not allow metabolic disorders, however, if this happens, you must seek help from a doctor as soon as possible to undergo a clinical examination in order to make an accurate and correct diagnosis.