Acidosis in children causes. Acidosis: main causes, symptoms and treatment

The acid-base balance is regulated by the body systems, which allows the latter to function normally. When acidosis occurs, we are talking about the development of an acid disorder in the direction of increase, which is the main symptom. Reasons lead to treatment. Metabolic acidosis is considered separately.

If the amount of acid in the body increases, then acidosis develops. The reason is its insufficient excretion from the body and oxidation. It also contributes to intestinal disorders, fasting and a feverish state, which leads to the formation of acetoacetic acid, acetone in the urine, a coma in severe cases.

The site site identifies several types of acidosis:

compensated type.
subcompensated type.
uncompensated type.
Gas in case of violation of ventilation of the lungs and inhalation of a large amount of CO2.
Non-gas - is divided into:

Metabolic - the accumulation in the tissues of acidic products that are destroyed in the body.
Excretory - the absence of excretion of non-volatile acids by the kidneys and an increase in the gastrointestinal tract loss of bases.
Exogenous - intake a large number elements involved in the formation of acids.
Mixed.

metabolic acidosis

The most common type of acidosis is metabolic. In this form, a lot of acid is produced, which is excreted in very small quantities.

Metabolic acidosis is divided into types:

Diabetic ketoacidosis, in which there is an excess of ketone bodies in the body.
Hyperchloraemic acidosis is formed when bicarbonate is lost, for example, after diarrhea.
Lactic acidosis - accumulation of lactic acid due to alcohol abuse, large physical activity, malignant tumors, hypoglycemia, the use of certain medications, anemia, convulsions, etc.

Metabolic acidosis manifests itself in the following symptoms:

A stunned, soporous or inhibited state.
Rapid breathing.
Shock and, as a result, death.

This type of disease is diagnosed by a blood test for acid-base balance. Treatment is aimed at eliminating the underlying cause. Sodium bicarbonate or sodium bicarbonate solution is administered intravenously. To avoid the fatal outcome that metabolic acidosis leads to, it should be treated.

lactic acidosis

Lactic acidosis is another common disease in which there is a significant accumulation of lactic acid. Type A is marked by obvious tissue anoxia. Type B practically does not manifest itself.

Type A is more common. Type B manifests itself very quickly, the reasons for which scientists have not yet reliably identified.

Type A lactic acidosis develops due to:

Diabetes.
epilepsy.
Convulsive conditions.
Hodgkin's disease.
Diseases of the liver and kidneys.
Neoplasia.
Myelomas.
infections.
Leukemia.
Bacteremia.
Generalized lymphoma.

Type B lactic acidosis develops due to exposure to pesticides, toxins, and drugs.

Causes of acidosis

Maintaining a normal acid-base balance is as important a factor as the absence of any infectious diseases. The main causes of acidosis are lifestyle, sedentary daily routine and malnutrition. It also affects the environment in which a person lives.

Nutrition plays a very important role. It seems that only acidic foods contribute to the development of acidosis. In fact, the acid in the body is the result of the breakdown and oxidation of food elements. It is important that the kidneys and lungs work well at the same time. The kidneys help in the elimination of non-volatile elements, and the lungs - volatile ones.

In addition, the metabolism should not be disturbed in the body, and there should also be no chronic diseases, which provoke a latent course of acidosis. These include tumors allergic reactions, neuroses, rheumatism, tissue inflammation, etc.

Acidosis symptoms

Acidosis is often manifested by the symptoms that express the main disease. AT mild form it may not show up at all. Sometimes it causes nausea, vomiting and fatigue. The severe form is manifested in violations of the frequency and depth of breathing, heart contractions and stupor. Also, the severe form is marked by metabolic disorders in the brain. This leads to constant drowsiness and coma.

The acute form of acidosis is recognized by the appearance of diarrhea and insufficient blood supply to the tissues. Reduced blood flow provokes dehydration, shock, acute blood loss and heart failure.

In children, acidosis may occur due to congenital disease. This affects its development, leads to convulsions and inhibition of character.

The initial stage can be recognized by:

Weaknesses.
Headache.
Drowsiness.
Lethargy.
oppression nervous system.

The aggravation of acidosis is accompanied by the appearance of:

Increased breathing and heart rate.

Digestive problems: diarrhea, vomiting, nausea, leading to dehydration.

In diabetes, there is a smell of fruits in the mouth, among other signs.

acidosis and alkalosis

are deviations in violation of metabolic processes in the body. Acidosis is an increase in the level of acids. Alkalosis is a deviation towards alkalis.

With a compensated form of diseases, a change in sodium bicarbonate and carbonic acid occurs. In the decompensated form, there is a violation of the amount of acids and alkalis in the direction of an excess of one of the substances.

Quite often, acidosis occurs against the background of non-respiratory causes. This is the accumulation of lactic acid, acetoacetic or hydroxybutyric acid. The accumulation of lactic acid is often noted due to abnormalities in the functioning of the heart or lungs ( oxygen starvation). Also, the disease develops against the background of diarrhea. In this case, the body turns on compensatory functions when there is a balance between acids and alkalis.

Alkalosis and acidosis affect the functioning of the body. Breathing changes, vascular tone decreases, cardiac output decreases and arterial pressure. Violated water and electrolyte balance. The bones lose their hardness, gradually there are changes in the work of the heart.

Treatment of acidosis

Since acidosis practically does not manifest itself, the treatment is aimed at eliminating the causes of its occurrence. However, the phenomenon itself is not ignored. Acidosis is treated with protein foods with a mild form of its manifestation. Of the drugs, sodium bicarbonate is prescribed orally for a mild form or intravenously for a severe one. Calcium carbonate is prescribed if it is necessary to limit the amount of sodium and with hypocalcemia.

Metabolic acidosis is treated:

sodium bicarbonate.
Nicotinic acid.
Cocarboxylase.
Riboflavin mononucleotide.
Glutamic acid.
dichloroacetate.

In case of pathologies in the gastrointestinal tract, Rehydration salt, Dimephosphone is taken orally.

The main emphasis is on proper nutrition. During treatment, coffee and alcoholic beverages should be avoided. Fruits, fats plant origin, berries, fresh vegetables are taken along with white bread, pasta, animal fats. It is actively recommended to take a decoction of rice to remove toxins, toxins and other harmful elements.

Forecast

Acidosis affects the functionality of the whole organism. If the acid-base balance is disturbed, then other systems are also disturbed. The heart, lungs and kidneys are mainly affected. However, acidosis often indicates the development of other diseases that affect metabolic disorders. The prognosis depends entirely on therapeutic measures to eliminate the cause and the acidosis itself.

Life expectancy depends on how quickly a person treats acidosis. In some cases, we are talking about a fatal outcome if the patient does not take any measures.

The body is a very complex system consisting of various parts: organs, tissues, cells. And if there is a failure at some level, then the functioning of the whole organism will certainly be disrupted.

For example, if the amount of acids (they are certainly present in tissues, blood) increases, then acidosis will occur. What are its symptoms? And how should it be effective treatment?

Acidosis is not a disease in itself, but a condition that occurs as a result of an imbalance in the acid-base balance of the body.

Every body contains acids, they are necessary for its functioning. And in the normal state, these same acids should be excreted, which provides a balance.

But if this does not happen for some reason, then they will accumulate in the blood, urine and even in some organs. Alarming symptoms will certainly tell about this. It is worth noting that the treatment should be timely, since strong oxidation is not normal, it can lead to sad consequences.

There are several varieties of this disease. For example, if we take the mechanism of state development as the basis for classification, then we can distinguish the following types:

Respiratory acidosis occurs due to insufficient removal of carbon dioxide during breathing. It turns out that it accumulates in the blood and changes its composition.
Non-respiratory acidosis occurs due to the accumulation of non-volatile acids in the blood, which for some reason are not excreted, but remain in the body.

There is also a mixed form, in which both carbon dioxide and non-volatile acids accumulate.

Non-respiratory acidosis can also be classified:

Metabolic. This is the most common and at the same time complex form, in which endogenous acids begin to accumulate in the tissues of the body, disrupting their functioning. The symptoms are the most pronounced, immediate treatment is required.
Excretory. It occurs in case of violation of the excretory function of the body, for example, when kidney failure.
Exogenous. Its main reason is the intake of an excess amount of such substances into the body, which in the process of processing turn into acids and begin to accumulate, not having time to be excreted.

Depending on the concentration of acids (it is determined by the pH level), there are:

If the pH level is close to the lower limits of the norm, compensated acidosis is diagnosed. In this state, a person may not be aware of such changes for a long time, but they will gradually (sometimes over several years) disrupt the functioning of the body.
With a slight excess normal values it is a subcompensated form.
With a significant excess of the norm, they speak of a decompensated form. Usually the symptoms are obvious, the consequences can be sad, so immediate and competent treatment is required.

The reasons

Such a state cannot develop unreasonably. There are many negative factors that can provoke acid-base imbalance:

Manifestations

Symptoms of a disease such as acidosis, with a mild form of the disease or at its initial stage, may not appear in any way and do not bother. And sometimes they are expressed only in signs of the underlying disease, which led to the accumulation of acids and the development given state.

But it is important to recognize the manifestations in time in order to start treatment and avoid serious consequences, one of which is coma, and subsequently death.

Here are the symptoms to watch out for:

Diagnostics

You can identify acidosis with the help of blood and urine tests, since their composition will certainly change.

How to treat?

With a disease such as acidosis, immediate treatment is required, since in severe cases a fatal outcome is likely. So if there are alarming symptoms, consult a doctor immediately.

Here are the main steps:

Elimination of the cause of the development of the condition, that is, the treatment of the underlying disease or the elimination of pathologies. For example, diabetes mellitus requires the introduction of insulin. If the ventilation of the lungs is impaired, then it will be carried out artificially. You will also need to drain the lungs, remove sputum (suction) and take expectorants.
You have to follow a certain diet. The patient should consume more berries, vegetables, fruits, cereals, plant products. And strong tea and coffee, alcohol, fried, flour, smoked, pickled, sweet and salty should be abandoned.
The blood must be cleansed of toxins and acids. Plasmapheresis may be required.
In some cases, dialysis is effective.
In severe forms, fluid is administered intravenously, as well as sodium bicarbonate. If the patient can drink on his own, he should do so. It is effective to take soda dissolved in water.
If necessary, symptomatic treatment is carried out.

Acidosis is curable if measures are timely. Health to you!

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 excretion from the human body.

The sources of such a disorder are a large number of adverse factors, ranging from 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 the pH. This is achieved by taking medicines, observing a sparing diet and eliminating the underlying disease.

Etiology

It must be borne in mind that such a disorder in all cases acts as a consequence of another disease, which means that it should be considered not as a single disease, but as a clinical manifestation.

Thus, metabolic acidosis causes the following:

malignant neoplasms, regardless of their location;
acute or chronic;
decrease in blood glucose levels;
shock conditions;
heavy;
prolonged oxygen starvation of the body;
the course of pathologies from the kidneys;
the strongest;
diseases accompanied by convulsive seizures;
or lack of adequate therapy;
or ;
severe injuries;
transferred earlier surgical intervention;
infectious pathologies of a purulent nature;
violation of the functioning of the intestine;
Budd-Chiari syndrome;
violation of the circulatory process;
cyclic vomiting syndrome;
fever.

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

the period of bearing a child;
long-term alcohol abuse;
adherence to overly strict diets or prolonged refusal to eat;
prolonged exposure to stressful situations;
heavy physical exertion.

In addition, a predisposing factor is considered to be an overdose of drugs, namely:

"Dimedrol";
sweeteners;
medicines containing iron;
sodium nitroprusside;
salicylates;
"Aspirin".

Also, the likelihood of developing such an ailment is greatly increased by maintaining a sedentary lifestyle and poor nutrition.

The pathogenesis of metabolic acidosis is that there is a production of a large number of metabolic products of acidic genesis in conjunction with a violation of the functioning of the kidneys, which is why they cannot remove toxins from the body.

Classification

Clinicians distinguish several degrees of severity of the course of such a pathological condition:

compensated metabolic acidosis - while the pH value is 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 a controlled course of diabetes mellitus;
non-diabetic ketoacidosis - is formed against the background of other adverse underlying causes;
hyperchloremic acidosis - is a consequence of an insufficient content of sodium bicarbonate or excessive losses of such a substance through the kidneys;
lactic acidosis - characterized by the accumulation of a large amount of lactic acid.

The latter type, in turn, has several varieties:

form A - characterized by the most severe course;
form B;
unusual shape d.

In addition, it is customary to distinguish:

high anion gap acidosis;
acidosis with a 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

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

The main manifestations are:

quickening of breathing;
persistent nausea and vomiting that does not improve general condition person;
shortness of breath, even at rest;
the strongest weakness;
painful pallor skin and visible mucous membranes;
slowdown heart rate;
decrease in blood tone values;
dizziness;
lethargy;
bouts of loss of consciousness;
convulsive seizures;
drowsiness;
feeling short of breath;
smell of acetone oral cavity;
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 deliver the patient to a medical facility as soon as possible or call an ambulance team 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.

Diagnostics

The main measures to make the diagnosis of "metabolic acidosis" are laboratory research. However, the process of diagnosing should have an integrated approach, which is determined by the need to find the cause of the formation of such a problem.

Primary diagnosis includes:

studying the history of the disease;
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;
measurement 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 provocative disease.

Among the laboratory tests it is worth highlighting:

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

General instrumental procedures, such as ultrasound and radiography, CT and MRI, ECG and biopsy are necessary to detect malignant tumors, as well as to establish the fact of damage to the liver, kidneys or other internal organs.

Treatment

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

Medical treatment is aimed at the use of:

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";
"Xylat";
"Pyridoxine";
"Rheosorbilact";
"Cyanocobalamin";
"Metroclopramide".

In addition, compensation for metabolic acidosis should include:

hemodialysis;
oxygen inhalations;
intravenous administration of glucose - prohibited only in diabetes mellitus;
adherence to a sparing diet - a diet is necessary to reduce fluid loss with profuse vomiting or diarrhea, as well as to improve the digestion of food.

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

Without the elimination of the fundamental negative source, it is impossible to completely get rid of such a pathology. Treatment of the provocative 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 rejection of bad habits;
balanced diet;
taking medications in accordance with the prescription of the attending physician;
constant monitoring of blood glucose levels, especially for people with diabetes;
maintaining a moderately active lifestyle;
avoiding the influence of stressful situations;
timely diagnosis and full treatment of ailments that can lead to the described violation.

In addition, it is mandatory to pass several times a year full examination in medical institution with visits to all specialists and the implementation of relevant laboratory and instrumental procedures, in particular, a complete blood count. We must always remember that the disease is easier to prevent than to cure, and for this it is necessary to 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.

Is everything correct in the article with medical point vision?

Answer only if you have proven medical knowledge

is a disorder acid-base balance, which is characterized by a decrease in the concentration of bicarbonates against the background of a normal or elevated plasma acid content. Key Signs - Decreased pH arterial blood to a level of 7.35 and below, a deficiency of alkaline bases of more than -2 mmol / liter, normal or increased partial pressure of carbon dioxide. Clinically manifested by depression of the myocardium, respiratory center, decreased sensitivity to catecholamines. It is diagnosed on the basis of the results of a laboratory study of acid-base balance indicators. Specific treatment is infusion of buffer solutions.

ICD-10

E87.2 P74.0

General information

Metabolic acidosis (MA) or acidemia is a condition associated with a change in the activity of biologically significant proteins against the background of a shift in acid-base acidic acid balance. Develops in severe somatic diseases, some poisonings, shocks of any origin. Moderate acidemia is not accompanied by clinical symptoms. When the cause of the failure is eliminated, the normal state of the internal environment is restored without medical intervention. Severe acidosis requires treatment in the ICU because of the high risk of respiratory and cardiovascular events. Patients need constant hardware monitoring of vital signs, daily and sometimes hourly blood sampling for laboratory tests.

The reasons

The cause of acidemia is hyperproduction or reduced excretion of acids, as well as increased excretion of alkaline components of the blood. Metabolic acidosis occurs in all cases of shock, clinical death, and postresuscitation illness. In addition, pathology can develop with a variety of pathological processes of a therapeutic and surgical profile. Depending on the underlying disorder, acidification may be due to lactate or ketone bodies. There are the following types of this state:

lactic acidosis. Occur when the processes of anaerobic glycolysis in the muscles are enhanced. Severe forms of lactic acidosis occur in patients with severe tissue hypoxia, respiratory failure, and a decrease in systolic blood pressure below 70 mm Hg. Art. Observed in sepsis, hypovolemia, synthesis of a large amount of D-lactate by intestinal microflora. Physiological cause changes in acid-base balance is considered to be active physical work, including weightlifting. Acidification does not require correction and disappears on its own soon after muscle relaxation.
Ketoacidosis. They are a symptom of somatic diseases. They are found in diabetes mellitus, chronic and acute renal failure, alcohol poisoning, methyl alcohol, ethylene glycol, salicylates, impaired excretory function of the liver. In addition, the concentration of ketone bodies increases at the terminal stage of shock, with the development of multiple organ failure.
Loss of bases. It occurs in a number of diseases of the gastrointestinal tract: prolonged diarrhea, intestinal fistulas, intestinal derivation of urine. The latter is the result of a surgical operation, during which the ureters are removed into the intestine in case of failure Bladder. Urine has a pH of 5-7, which means it is acidic. When it enters the intestine, it neutralizes the intestinal alkaline environment.

Pathogenesis

Metabolic acidosis leads to a decrease in the concentration of HCO 3 and an increase in the amount of Cl - . Potassium ions in cells are actively replaced by sodium and hydrogen, there is an increase in the volume of K + in plasma. In the absence of renal failure, excess potassium is excreted in the urine. At the same time, its level in the blood remains close to normal, intracellular hypokalemia is formed. In acute renal failure, the plasma contains an increased amount of K + ions. Small shifts are compensated by buffer systems: bicarbonate, phosphate, hemoglobin, protein. They reversibly bind protons, maintaining homeostasis, but the action of these systems is not enough in massive acidosis. There is a decrease in pH, which is reflected in the conformation of amphoteric compounds. The activity of hormones, neurotransmitters changes, the functions of receptor apparatuses are disturbed.

Classification

There are several classifications of alkalemia. One of the most common division criteria is the anion difference - the difference in the concentrations of K +, Na + and CL -, HCO 3 -. Normally, it is 8-12 mmol / liter. If this indicator is preserved, they speak of alkalosis with a normal anion hole, an excess indicates a decrease in the concentration of unmeasured cations Mg + , Ca + or an increase in the level of phosphates, albumins, organic acids. To clinical practice The following classifications are used according to the level of MA compensation:

Compensated. It is asymptomatic, homeostasis is maintained due to the active work of compensatory mechanisms. pH is maintained at 7.4, base deficit is zero, CO2 partial pressure is maintained at 40 mmHg. Art. It is detected during prolonged work of a large amount of muscle tissue, as well as at the initial stage internal diseases. Medical correction is not required.
Subcompensated th. The hydrogen index is kept within the normal range or slightly decreases (7.35-7.29). There is a slight deficit of bases (up to -9). pCO2 decreases due to compensatory hyperventilation, but does not overcome the value of 28 mm Hg. Art. There is a nonspecific mild clinical picture. The use of buffer fluids is not necessary.
decompensated. pH drops below 7.29, BE deficiency overcomes -9 mmol/liter. Not compensated by pulmonary hyperventilation. The partial pressure drops to 27 mm Hg. Art. or below. There is a detailed symptomatology, a sharp deterioration in the patient's well-being. Required urgent care using buffer solutions.

Symptoms of metabolic acidosis

Compensated or subcompensated varieties are asymptomatic. With a deficiency of bicarbonates of more than -10, a pH value of less than 7.2, compensatory hyperventilation occurs. It manifests itself in the form of deep slow breathing. As the condition decompensates, the patient develops Kussmaul breathing. Chronic acidosis in children leads to delays in growth and development. Other Clinical signs depend on the underlying pathology. Diarrhea, itching of the skin, polyuria, visual disturbances, dizziness may occur. A history of prolonged fasting, high doses of salicylates, ethylene glycol, methanol or ethanol, the presence of diabetes mellitus, intestinal disorders, and chronic kidney failure.

Severe metabolic disorders potentiate hypotension. The reaction to the introduction of pressor amines is reduced or absent. A decrease in myocardial contractility, compensatory tachyarrhythmia is revealed. Plasma hyperkalemia against the background of renal failure causes atrial fibrillation (atrial fibrillation). There are signs of impaired atrioventricular conduction. Patients complain of chest pain, palpitations, shortness of breath. On physical examination, the skin is pale or cyanotic, cold to the touch, the pulse is arrhythmic, weak filling and tension, breathing is deep, heavy, noisy. Encephalopathy may develop.

Complications

Severe metabolic acidosis at the terminal stage causes depression of the respiratory center. Hyperventilation is replaced by weak shallow breathing. Brain hypoxia develops, leading to loss of consciousness and coma. The activity of the kidneys, liver is disturbed, multiple organ failure occurs. Disturbance of neuromuscular conduction progresses, which causes a disorder in the activity of all body systems. Initially, atrial arrhythmias spread to the ventricles. Fibrillation of the latter is observed, diagnosed clinical death.

Diagnostics

Diagnosis of MA in ICU patients is carried out by an anesthesiologist-resuscitator. In the presence of chronic somatic diseases, it is necessary to consult narrow specialists: an endocrinologist, a surgeon, a nephrologist, a hepatologist. Chronic metabolic acidosis can be diagnosed by a doctor general practice at the outpatient clinic. The diagnosis is established on the basis of data from the following studies:

physical. It does not allow to accurately determine the presence of changes, since the signs of the disorder are too non-specific and can occur in many other pathological processes. However, the corresponding clinical picture gives grounds for the appointment of an analysis of acid-base balance and plasma electrolytes.
Laboratory. It is the basis of diagnostic search. Acidemia is diagnosed with a moderate or significant decrease in pH, a deficiency of bicarbonates, and a decrease in the partial pressure of carbon dioxide. To determine the type of acidosis, an anion gap is assessed. To clarify the mechanism of base loss, it may be necessary to study the anion hole not only in plasma, but also in urine.
Hardware. It is carried out to identify the underlying disease, as well as to diagnose emerging changes. On the ECG, there is a sharpening of the T wave, the expansion of the QRS complex, the disappearance of the P wave, large-wave or small-wave atrial fibrillation, uneven intervals between ventricular complexes. When there is a blockage in big circle there may be ultrasound signs of an enlarged liver, spleen, accumulation of fluid in the abdominal cavity.

Treatment of metabolic acidosis

Therapy of MA without eliminating its causes is inappropriate, based on the detection and treatment of the underlying disease. With diabetic ketoacidosis, correction of blood sugar levels is necessary, with lactic acidosis, relief of tissue ischemia and hypoxia. At shock states the patient is shown appropriate resuscitation measures. Treatment of the root cause of acidemia is carried out in parallel with the normalization of the acid-base composition of the internal environment. For this, the following methods are used:

Medical. In decompensated forms of the disease, correction is carried out by infusion intravenous administration sodium bicarbonate. Otherwise, buffer solutions are not used. It is possible to transfuse lactasol, which is metabolized in the liver with the formation of HCO3. The electrolyte balance is restored with the infusion of disol, acesol, trisol. With hypoproteinemia, protein transfusion is indicated. Normalization of oxidative processes in tissues is carried out by prescribing multivitamin complexes, pantothenic and pangamic acids.
Hardware. Necessary in the complicated course of the process for the correction of vital functions. Respiratory failure is an indication for transferring the patient to artificial lung ventilation, a decrease in kidney function requires hemodialysis. With a decrease in blood pressure, a hardware (through an injectomat) infusion of vasopressors is performed. With ventricular fibrillation, electropulse treatment, indirect heart massage are used.

Forecast and prevention

The course of the disorder directly depends on the underlying pathological process and the possibility of its complete elimination. After the elimination of the causes of acidemia, acid-base disorders can be easily corrected even at the stage of decompensation. Drug replenishment of the deficiency of bicarbonates while maintaining the etiological factor of acidification does not allow to achieve a stable normalization of the pH and BE (an indicator of excess / lack of HCO 3). Prevention consists in the timely treatment of processes that can cause acidosis, the regulation of blood sugar levels, and the passage of a hemodialysis procedure for chronic renal failure. In the ICU, metabolic acidosis is detected and corrected for early stage with daily study of indicators of acid-base balance.

Under medical term"acidosis" refers to a condition of the human body in which the acid-base balance is disturbed.

Causes of acidosis

Violation of the acid-base balance occurs as a result of insufficient oxidation and excretion of organic acids. Generally, at healthy person these products are excreted from the body quickly enough. In some diseases and conditions (for example, during pregnancy, intestinal disorders, starvation, feverish diseases, etc.), they are excreted very slowly. In mild cases, this is manifested by the appearance of acetone and acetoacetic acid in the urine (this condition is called acetonuria), and in severe cases (for example, in diabetes mellitus), it leads to coma, shock, and even death.

Thus, the causes of acidosis, or rather, the factors that accompany the development of this condition, can be:

Pregnancy;
Rigid diets, starvation;
Smoking, alcohol abuse;
Poisoning and other disorders of the gastrointestinal tract;
Diseases characterized by metabolic disorders ( diabetes, febrile conditions, etc.);
Dehydration of the body (regardless of the cause that caused it);
Malignant formations;
Oxygen starvation (with heart failure, states of shock, anemia);
kidney failure;
Poisoning chemicals, whose metabolism can lead to the formation of excess acids;
Respiratory failure in severe form (with emphysema, pneumonia, hypoventilation, etc.);
Loss of bicarbonate by the kidneys;
Hypoglycemia (a condition characterized by a decrease in blood glucose levels);
Circulatory failure (for example, with pulmonary edema);
Taking certain medications (for example, calcium chloride, salicylates, etc.).

It should be noted that it is not always possible to establish the cause of acidosis.

Classification of acidosis

By origin, acidosis is divided into:

Respiratory (develops due to inhalation of air with a high concentration of carbon dioxide);
Non-respiratory (due to an excess of non-volatile acids);
Mixed.

In turn, non-respiratory acidosis is classified into:

Excretory: develops as a result of a violation of the function of removing non-volatile acids from the body, most often in kidney diseases;
Exogenous: it is already characterized by the entry into the body of an increased amount of substances that are converted in the process of acid oxidation;
Metabolic: due to the accumulation of endogenous acids in tissues due to their insufficient binding and / or destruction. The most difficult state.

According to the pH level (at a rate of 7.25-7.44), acidosis is divided into:

Compensated - a shift in blood pH towards the lower limit of the physiological norm to the level of 7.35;
Subcompensated - a more pronounced shift to the "sour" side - pH 7.35-7.29;
Decompensated - a decrease in the pH level of less than 7.29.

In the event that the pH level in the body reaches extremely low (less than 7.24) indicators (in fact, as well as extremely high), proteins are denatured (i.e., their natural properties are lost), and the function of enzymes decreases, cells are destroyed - this can lead to the death of the body.

Acidosis can cause critical conditions such as:

Increased blood clotting;
brain dysfunction;
Decrease in the volume of circulating blood;
Critical fluctuations in blood pressure;
Dehydration;
peripheral thrombosis;
myocardial infarction;
Infarction of parenchymal organs;
Coma;
Death.

Acidosis symptoms

Symptoms of acidosis are difficult to differentiate from signs of various diseases, and in mild forms they are not at all associated with a violation of acid-base balance.

Mild acidosis symptoms may include:

Short-term nausea and vomiting;
General malaise;
fatigue;

More severe conditions of acidosis may be accompanied by:

cardiac arrhythmia;
Disorders of the central nervous system: lethargy, dizziness, confusion, drowsiness, loss of consciousness;
shortness of breath;
Hyperpnea (an increase in the depth of breathing, and then its frequency);
Increased heart rate;
Signs of a decrease in the volume of extracellular fluid (ECF), especially in diabetic acidosis;
An increase in blood pressure;
Growing stupor.

Severe acidosis can lead to circular shock, which develops as a result of impaired myocardial contractility and the reaction of peripheral vessels to catecholamines.

Diagnosis of acidosis

As mentioned above, the symptoms of acidosis are not specific. In addition, they are very often masked by signs of the underlying disease, so the diagnosis is not always possible to establish immediately.

For accurate diagnosis, patients undergo the following studies:

Blood test to determine the pH level in the urine;
Analysis of arterial blood for the presence of serum electrolytes;
Analysis of arterial blood to determine its gas composition.

The last two studies make it possible to determine not only the presence of acidosis in a person, but also its type (respiratory or metabolic).

In order to determine the cause of acidosis, a number of additional studies may be needed.

Treatment of acidosis

In view of the fact that the described condition is the result of a violation of the functioning of body systems, the goal of treating acidosis is to eliminate the factors that have become a trigger. In particular, we are talking about the treatment of major diseases, pathological conditions or dysfunctions, which provoked a shift in the acid-base balance of the body.

Correction severe forms acidosis means:

Elimination of the provoking factor;
Normalization of hemodynamics: improvement of the rheological properties of blood, restoration of microcirculation, elimination of hypovolemia;
Correction of electrolyte metabolism;
Elimination of hypoproteinemia;
Improvement of renal blood flow;
Strengthening the hydrocarbon buffer system;
Improving oxidative processes in tissues by introducing ascorbic acid, glucose, riboxin, thiamine, insulin, pyridoxine;
Improving pulmonary ventilation (transition to artificial ventilation - in extreme cases).

Targeted correction of the acid-base state by introducing buffer solutions is carried out only at a pH level of less than 7.25 (with decompensated acidosis).

Symptomatic treatment of acidosis involves drinking plenty of water, ingestion of soda, as well as the elimination of concomitant symptoms (malaise, nausea, arrhythmias, high blood pressure etc.). In case of poisoning, drugs are prescribed that remove toxic substances from the body; in severe cases, dialysis is performed.

Treatment of acidosis in children is similar to the treatment of this condition in an adult.