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Acid-Base Balance

What is acid-base balance?

Your blood needs the right balance of acidic and basic (alkaline) compounds to function properly. This is called the acid-base balance. Your kidneys and lungs work to maintain the acid-base balance. Even slight variations from the normal range can have significant effects on your vital organs.

Acid and alkaline levels are measured on a pH scale. An increase in acidity causes pH levels to fall. An increase in alkaline causes pH levels to rise.

When the levels of acid in your blood are too high, it’s called acidosis. When your blood is too alkaline, it is called alkalosis.

Respiratory acidosis and alkalosis are due to a problem with the lungs. Metabolic acidosis and alkalosis are due to a problem with the kidneys.

Each of these conditions is caused by an underlying disease or disorder. Treatment depends on the cause.

Respiratory acidosis

When you breathe, your lungs remove excess carbon dioxide from your body. When they cannot do so, your blood and other fluids become too acidic.

Symptoms of respiratory acidosis

Symptoms may include fatigue, shortness of breath, and confusion.

Causes of respiratory acidosis

There are several different causes of respiratory acidosis including:

  • chest deformities or injuries
  • chronic lung and airway diseases
  • overuse of sedatives
  • obesity

Types of respiratory acidosis

There are no noticeable symptoms of chronic respiratory acidosis. This is due to the fact that your blood slowly becomes acidic and your kidneys adjust to compensate, returning your blood to a normal pH balance.

Acute respiratory acidosis comes on suddenly, leaving the kidneys no time to adjust. Those with chronic respiratory acidosis may experience acute respiratory acidosis due to another illness that causes the condition to worsen.

Diagnosis of respiratory acidosis

A complete physical examination is necessary. Diagnostic testing may include:

  • arterial blood gas test
  • metabolic panel
  • pulmonary function test
  • chest X-ray

Treatment of respiratory acidosis

A doctor should be seen immediately to treat acute respiratory acidosis, as this can be a life threatening condition. Treatment is targeted to the cause.

Bronchodilator medications may be given to correct some forms of airway obstruction. If your blood oxygen level is too low, you may require oxygen. Noninvasive positive pressure ventilation or a breathing machine may be necessary.

To treat chronic respiratory acidosis, the underlying cause needs to be determined in order for proper treatment to take place. The cause could be from an organ deformity, an infection, or some type of inflammation. Each cause may require a different treatment ranging from antibiotics to a breathing machine.

In either case, if you smoke, you will be advised to stop.

Complications of respiratory acidosis

Respiratory acidosis is serious and requires immediate medical attention. Potential complications of untreated respiratory acidosis include respiratory failure, organ failure, and shock.

Preventing respiratory acidosis

You can take steps to help prevent some of the conditions that lead to respiratory acidosis. Maintain a healthy weight. Take sedatives only under strict doctor supervision and never combine them with alcohol. Do not smoke.

Metabolic acidosis

Metabolic acidosis occurs either when your body produces too much acid, or when your kidneys are unable to remove it properly.  

Symptoms of metabolic acidosis

Symptoms can include rapid breathing, fatigue, and confusion.

Causes of metabolic acidosis

There are three main types of metabolic acidosis. Diabetic acidosis, or diabetic ketoacidosis, is a buildup of ketone bodies. This is usually due to uncontrolled type 1 diabetes. Hyperchloremic acidosis is when your body loses too much sodium bicarbonate, often after severe diarrhea.

Lactic acidosis is when too much lactic acid builds up. This can be due to:

  • prolonged exercise
  • lack of oxygen
  • certain medications, including salicylates
  • low blood sugar, or hypoglycemia
  • alcohol
  • seizures
  • liver failure
  • cancer
  • kidney disease
  • severe dehydration
  • poisoning from consuming too much aspirin, ethylene glycol, and methanol

Diagnosing metabolic acidosis

Diagnostic testing may include serum electrolytes, urine pH, and arterial blood gases. Once acidosis is confirmed, other tests may be necessary to pinpoint the cause.

Treatment of metabolic acidosis

The underlying condition behind the acidosis must be treated. In some cases, sodium bicarbonate is prescribed to return the blood to a normal pH.

Complications of metabolic acidosis

Severe cases can lead to shock and can be life threatening.

Alkalosis

Alkalosis is when alkaline levels are too high due to decreased carbon dioxide or increased bicarbonate. There are five kinds of alkalosis.

Symptoms of alkalosis

Symptoms of alkalosis may include:

  • muscle twitching, hand tremor, muscle spasms
  • numbness and tingling
  • nausea
  • vomiting
  • lightheadedness
  • confusion

Causes and types of alkalosis

Respiratory alkalosis is when your blood has low levels of carbon dioxide. This can be caused by a number of factors, including:

  • lack of oxygen
  • high altitude
  • fever
  • lung disease
  • liver disease
  • salicylate poisoning

When you have alkalosis your carbon dioxide levels are low. This causes your body to release more bicarbonate to return your blood pH level back to normal. This is called compensated alkalosis. Your blood pH levels will test normal, however your kidneys are releasing more bicarbonate, compensating for the lower levels of carbon dioxide.

When your blood has too much bicarbonate, it is called metabolic alkalosis. This can happen from prolonged vomiting. Prolonged vomiting can also make you lose too much chloride. This is called hypochloremic alkalosis. Some diuretic medicines can cause you to lose too much potassium. This is called hypokalemic alkalosis.

Diagnosing alkalosis

Along with a physical exam, diagnostic testing for alkalosis may include a metabolic panel, blood gas analysis, urinalysis, and urine pH.

Treatment for alkalosis

Some medications (such as chloride and potassium) can help correct chemical losses. Further treatment will depend on the cause. Your physician will need to monitor your vital signs and create a proper plan to correct your pH imbalance.

Complications of alkalosis

In severe cases, alkalosis can lead to heart arrhythmias or coma.

What is the outlook for unbalanced acid and alkaline?

Alkalosis and acidosis can become very serious if they go untreated. Make an appointment with your doctor if you think you have developed symptoms of either condition.

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