Acidosis

Metabolic acidosis is a violation of the acid-base state. The disease is characterized by a decrease in blood pH, and there is also a low concentration of bicarbonate. Experts distinguish between high and normal anion gap acidosis. This depends on the presence or absence of unmeasured anions in the plasma. If the body cannot cope with the excretion of acid, too much of it is produced, that is, there is a risk of developing a severe form of acidosis and coma. At the first sign of an unhealthy condition, you should seek therapeutic help.

Symptoms

Moderate disturbance in the range of BE up to 9 mmol / L often develops without obvious symptoms. If the pH drops to 7.2, then breathing becomes deeper and faster. As the pH further decreases, the following is noted:

suppression of the myocardium;
decreased sensitivity to catecholamines;
decreased performance of the heart;
hypoxic encephalopathy.

Mild acidosis can present with nausea and vomiting. Constant fatigue and fatigue are noted. Quite often, patients do not pay attention to the changed breathing, although this symptom is indicative. As acidosis progresses, drowsiness and severe weakness increase. Without timely correct assistance, extremely severe symptoms of acidosis are possible:

demineralization of bones;
shock;
coma.

The disease is confirmed by a blood sample taken from the radial artery at the wrist. The content of carbon dioxide and bicarbonate is studied. With a decrease in blood pH by 0.10 units, the concentration of K + increases by 0.6 mmol. Hyperkalemia can lead to an abnormal acid-base state.

Causes of metabolic acidosis

Experts distinguish three main categories of factors leading to a violation. It:

taking acid-forming substances;
excessive production of acid in diseases;
impaired renal function.
Metabolic acidosis with an increased anion gap usually progresses with ketoacidosis. The formation of ketone bodies is accelerated as a result of:

progression of diabetes;
malnutrition;
regular alcohol consumption;
diabetes mellitus;
syndrome of acute or chronic autointoxication;
cardiogenic shock.
Other causes of acidosis include kidney failure. Cases of various degrees of poisoning with salicylic acid salts, ethylene glycol, and methyl alcohol have been reported. As for lactic acidosis, it is provoked by a decrease in the amount of oxygen supplied to the tissues. As a result, too much lactate is produced. Ultimately, severe acidosis is observed. The problem is inherent in a number of conditions, accompanied by insufficient blood supply to the tissues.

Normal anion gap metabolic disorder, also called hyperchloremic acidosis, is caused by:

loss of total bicarbonate by the kidneys;
intake of mineral acids;
loss of HCO3 through the gastrointestinal tract.

At risk are patients suffering from SLE, nephrotic syndrome, multiple myeloma, cystinosis. A certain danger is posed by:

pancreatic fistula;
prolonged diarrhea;
ureterosigmoidostomy;
long-term oral administration of hydrochloric acid, ammonium chloride, calcium chloride.

Diagnosis of the disease

Confirm metabolic acidosis by determining the anion gap. The increased rate may be due to a clinically obvious cause. This is an irregular visit to hemodialysis sessions, hypovolemic shock, and so on. If the cause is unknown, then it is necessary to donate blood for determination:

Sahara;
urea nitrogen;
creatinine;
lactate.

Standard analysis includes determination of the presence of salicylates only, or in addition to methanol and ethylene glycol.

Blood gas analysis indicates a decrease in bicarbonate levels with a compensatory decrease in PACO2. In classical metabolic acidosis, the partial pressure of oxygen in arterial blood is equal to the concentration of bicarbonate multiplied by 1.5 + 6-10 mm Hg. Art. If a deviation from the indicator is registered, then respiratory dysfunction is questionable.

Which doctor should I go to?

By itself, metabolic acidosis is not an independent disease. The condition is a consequence of other disorders in the body and tissue damage. To identify the main cause of the problem, you need to contact doctors such as:

ENDOCRINOLOGIST
NEPHROLOGIST

In critical situations, the help of an ambulance doctor, resuscitation specialist is needed. It is important for a specialist to obtain as much information as possible about the patient’s condition, therefore, the following questions should be answered exhaustively:

How long has the general condition worsened, have signs of acidosis appeared?
Are there any chronic diseases?
What acute illnesses have you suffered?
Lifestyle, field of activity?
Nutritional features?
Alcohol addiction?

Next, the doctor gives a referral for blood tests. Urine testing may be required. Hardware diagnostics for acidosis is not provided. However, ultrasound and other methods are necessary if the specialist has a suspicion of damage to internal organs, which is not reflected in the history. A cardiologist and an oncologist can take part in the diagnosis and further therapy.

Treatment

After stopping the acute period, stabilization of the patient is transferred to the effect on the main cause. In most cases, the therapy is complex. The correction assumes:

restoration of microcirculation;
improvement of hemorheology;
improved ventilation of the lungs;
normalization of electrolyte metabolism;
stabilization of the level of protein in the blood plasma.
In parallel with this, the blood supply to the kidneys is normalized. It is important to improve the oxidative processes in the tissues. To do this, appoint:

3d image of the flow of blood inside an artery

thiamine;
glucose;
riboxin;
insulin;
pyridoxine;
ascorbic acid.

It is also necessary to strengthen the bicarbonate buffer system. The introduction of buffers is shown only at the decompensated form of pH 7.25 or less. Treatment of acidosis involves the use of solutions:

4.2% sodium bicarbonate;
11% sodium lactate;
3.66% triamine;
lactasol.

In case of poisoning, toxic substances are removed from the body. A serious condition requires dialysis. If acidosis is provoked by diabetes mellitus, then the patient is prescribed insulin. The potassium deficiency characteristic of acidosis is corrected by oral or parenteral administration of KCI.

Throughout the course of treatment, you must adhere to a special diet. Allowed for use:

compotes and berry decoctions;
whole grains;
raw fruits and vegetables.
Vegetable products account for 60% of all food. Of these, 2/3 are raw fruits and vegetables.

If the cause of the acid-base failure stops on its own, then healthy kidneys restore the natural volume of bicarbonate in a couple of days. When metabolic acidosis is associated with chronic renal failure, long-term, possibly even lifelong therapy is required.

Symptoms and treatment of acidosis are variable and may not reflect the severity of the condition, so therapy should only be prescribed by an experienced practitioner. Otherwise, you can provoke an exacerbation of the underlying disease, for example, heart failure.