Acidosis what tests to pass. Acidosis: causes, forms, manifestations, diagnosis, how to treat when dangerous

A shift in the acid-base balance with an increase in acidity and a decrease in the pH of the body's media characterizes its pathological conditions, combined common definition- acidosis.

The etiology of this condition is based on the accumulation and complexity of removing organic acid oxidation products from the body.

Causes

The presence of a large accumulation of acidic products in acidosis can be caused by various reasons.

Factors affecting the development of acidosis can be both external and internal. To external reasons development of acidosis include inhalation of air or vapors with a high content of carbon dioxide.

Internal reasons include functional disorders body systems that affect metabolic processes and the output of products of organic acids.

The causes of the development of acidosis can be certain processes in the body: diabetes, circulatory disorders, tumor processes, pregnancy, hypoglycemia, various genesis hypoxic conditions, disturbances in the activity of the kidneys, intoxication, starvation, side effects medical preparations etc. In some cases, the obvious causes leading to the appearance of acidosis are not determined.

Regardless of the cause that caused it, acidosis adversely affects the entire body of the patient. The worst prognosis for severe acidosis is shock or death.

The consequences of acidosis can be dehydration of the body, thickening of the blood, thrombosis, unstable blood pressure, myocardial infarction, liver, spleen, etc., functional disorders in the blood circulation of the brain and the flow of metabolic processes in it, i.e. the state of acidosis entails a violation of the activity of all vital organs.

Types of acidosis

The type of mechanism for the appearance of acidosis determines three types of acidosis: respiratory, non-respiratory and mixed type of acidosis.

Non-respiratory acidosis is classified in turn into several subspecies:

• A condition characterized by impaired renal function, accompanied by a lack of excretion of acids from the body, is called excretory acidosis.
• The most severe and complex condition, expressed by a significant accumulation of endogenous acids, refers to metabolic acidosis.
• The intake of a significant amount of a substance, which is then processed into acids, is referred to as an exogenous form of acidosis.

There is a classification of types of acidosis according to the level of pH. In this case, compensated, subcompensated and decompensated acidosis are determined.

Compensated acidosis is characterized by an insignificant change in pH and the ratio sodium salt carbonic acid to the components of the carbonate buffer. With compensated acidosis, with the help of hyperventilation of the lungs, a significant part of carbon dioxide and hydrogen ions are removed from the body, which cause a shift in the acid-base balance to the acid side.

As a response, with compensated acidosis, the kidneys also begin to intensively excrete hydrogen ions in the urine, and the process of reabsorption of sodium bicarbonate in the tubules increases.

The absence or lack of compensatory actions in the body provokes the development of decompensated acidosis.

The ratio of carbonic acid and sodium bicarbonate in decompensated acidosis changes significantly, and the pH decreases.

Metabolic, the most common acidosis, is subdivided into hyperchloremic acidosis, lactic acidosis and diabetic.

In hyperchloremic acidosis, the acid-base balance is disturbed due to the high content of chlorine in the blood plasma. This disruption results in a deficiency or total loss of sodium bicarbonate. The causes of hyperchloremic acidosis can be diseases of the kidneys, intestines, the introduction of ammonium chloride or hydrochloric acid into the body.

Lactic acidosis develops as a result of an excess of lactic acid in the body. Violations of the production of enzymes, unstable supply of muscles and tissues with blood or oxygen are the main causes of lactic acidosis. Often this species acidosis develops against the background. The cause of lactic acidosis can be malnutrition, the presence of an excess of meat, flour products in it, and the lack of fresh vegetables and fruits in the diet.

Diabetic acidosis appears as a complication of diabetes mellitus and indicates the presence of hyperglycemia and ketonemia. An increased content of lactic or p-hydrobutyric acid is found in the patient's blood. In diabetic acidosis, there is an acute shortage of carbohydrates in the cells of the body. This is the most severe manifestation of acidosis. The reason for this may be the late adoption necessary drugs or infection of the body with diabetes mellitus. The consequence of diabetic acidosis may be coma or death of the patient.

Symptoms and diagnosis of acidosis

Mild forms of acidosis do not give any characteristic clinic. Differentiating acidosis from other diseases is quite difficult, because. symptoms of acidosis do not indicate the development of disorders of the acid-base balance in the body. The presence of general malaise, mild nausea, vomiting, shortness of breath and palpitations, hanging blood pressure, disturbances in the action of the central nervous system should alert and serve as a reason for contacting a medical institution.

Diagnosis of acidosis is based on the analysis of the results of the pH indicator arterial blood, for analysis, blood is taken at the wrist from the radial artery. To determine the causes of acidosis in the blood, the amount of carbon dioxide and bicarbonate is checked. When examining the history, diagnosis of acidosis, the previous condition and illnesses of the patient are taken into account.

Diagnosis of acidosis is also carried out on the basis of the pH level in the urine, serum electrolytes and blood gases are examined. Other tests are done to determine the cause of the acidosis.

Acidosis correction

Considering that acidosis is not an independent disease, but occurs as a result of other disorders, the correction of acidosis is primarily aimed at treating the underlying disease or regulating dysfunctions in the body.

To correct acidosis of metabolic origin, it is prescribed intravenous administration fluids, and treatment of the underlying pathology.

Sodium bicarbonate in combination with glucose or sodium chloride is used in severe cases of acidosis.

Symptomatic treatment is used for mild acidosis. Dialysis is used in cases acute poisoning organism.

Prevention of acidosis

To prevent acidosis, it is necessary to carefully approach the issue of a balanced diet and timely treatment existing diseases. White bread, eggs, cheeses, meats, animal fats, eaten without restrictions, do more harm than good. Therefore, to prevent acidosis, it is necessary to use these products in moderation. Do not abuse coffee and alcohol. It is advisable to consume as many vegetables and fruits in raw form as possible.

Indispensable conditions for the prevention of acidosis are preventive visits to the doctor and careful treatment of already acquired diseases.

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

Causes of acidosis

Violation acid-base balance occurs as a result of insufficient oxidation and excretion of organic acids. In general, in a healthy person, these products are excreted from the body fairly quickly. 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 mellitus, feverish 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);
• Reception of individual medicines(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.

Symptoms of acidosis in mild form can be:

• 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 underlying diseases, pathological conditions or dysfunctions, which provoked a shift in the acid-base balance of the body.

Correction of severe forms of acidosis involves:

• 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.

Metabolic acidosis is one of the most frequent and dangerous forms of ASC disorders. Such acidosis can be observed in heart failure, many types of hypoxia, disorders of the liver and kidneys in the neutralization and excretion of acidic substances, depletion of buffer systems (for example, as a result of blood loss or hypoproteinemia).

causes of metabolic acidosis

Metabolic disorders leading to the accumulation of excess non-volatile acids and other substances with acidic properties.

† Lactic acidosis and increased levels of pyruvic acid in tissues ((for example, with various types of hypoxia: respiratory, cardiovascular, hemic, tissue; prolonged intense physical work, during which the formation of UA increases, and its oxidation is reduced due to oxygen deficiency; lesions liver).

† Accumulation of other organic and inorganic acids formed during the development of pathological processes that affect large arrays of tissues and organs. The development of this variant of metabolic acidosis is observed with extensive burns of the skin and mucous membranes; various types of inflammation (for example, with erysipelas, peritonitis, purulent pleurisy); massive injuries (for example, with prolonged crush syndrome, multiple body injuries).

† Ketoacidosis (due to acetone, acetoacetic and -hydroxybutyric acids), as a rule, is observed in patients with diabetes; with prolonged fasting, especially with a deficiency of carbohydrates; with prolonged febrile conditions; alcohol intoxication; extensive burns and inflammation.

Lack of buffer systems and physiological mechanisms to neutralize and remove excess non-volatile acids from the body.

TYPICAL CHANGES IN AFR

The main pathogenetic factor: the depletion of HCO 3 - (bicarbonate buffer) due to the accumulation of non-volatile compounds (lactate, CT).

Typical directions of changes in indicators of acid-base balance (capillary blood) in all non-gas acidosis:

The patient was admitted to the clinic with a preliminary diagnosis of diabetes mellitus.

Compensation mechanisms for metabolic acidosis

Compensation mechanisms for metabolic acidosis according to the speed of their activation and duration of functioning are divided into urgent and long-term (Fig. 13–5).

Rice. 13–5. Compensation mechanisms for metabolic acidosis.

Urgent Mechanisms for Reversal of Metabolic Acidosis

Urgent mechanisms for eliminating metabolic acidosis are to activate:

Bicarbonate buffer system of intercellular fluid and blood plasma. This system is able to eliminate even significant acidosis (due to its large buffer capacity).

Bicarbonate buffer of erythrocytes and other cells. This occurs with a significant acid load on the body.

Protein buffer system of cells of various tissues. It is observed in conditions of significant accumulation of non-volatile acids in the body.

Bicarbonate and hydrophosphate buffers of bone tissue.

Respiratory center, which provides an increase in the volume of alveolar ventilation, rapid removal of CO 2 from the body and often normalization of pH. It is significant that the "buffer capacity" of the external respiration system under conditions of metabolic acidosis is approximately two times greater than that of all chemical buffers. However, the functioning of this system alone is absolutely insufficient to normalize pH without the participation of chemical buffers.

Long-term mechanisms of metabolic acidosis compensation

Long-term mechanisms of metabolic acidosis compensation are implemented mainly by the kidneys and to a much lesser extent with the participation of bone tissue buffers, liver and stomach.

renal mechanisms. With the development of metabolic acidosis, the following are activated:

† ammoniogenesis (main mechanism),

† acidogenesis,

† secretion of monosubstituted phosphates (NaH 2 PO 4),

† Na + ,K + ‑exchange mechanism.

Collectively, renal mechanisms provide an increase in H + secretion in the distal renal tubule and bicarbonate reabsorption in the proximal nephron.

The participation of bone tissue buffers (bicarbonate and phosphate) in chronic acidosis also remains.

Hepatic compensation mechanisms consist in the intensification of the formation of ammonia and gluconeogenesis, detoxification of substances with the participation of glucuronic and sulfuric acids and their subsequent removal from the body.

The chronic course of metabolic acidosis is also characterized by an increase in the formation of hydrochloric acid by the parietal cells of the stomach.

Due to the activation of these mechanisms, metabolic acidosis can be compensated: the pH does not fall below 7.35. However, in case of insufficiency of buffer systems and physiological mechanisms to eliminate the shift in the acid-base balance, the pH of the blood drops beyond the normal range. In these cases, significant disorders of the body's vital functions are possible, including the development of coma.

One of the most important indicators of human health is the acid-base balance. In the process of life, many acids are formed in the body, which are usually quickly excreted in the urine, sweat or through the lungs. But with some diseases or disorders of the acid-base balance, acidosis occurs. a condition in which acids accumulate in tissues and act

destructive to them. Most often it occurs when there is a lack of minerals from food. In the process of neutralizing acids, salts are formed, which are excreted from the body. If there are not enough alkalis for this, then acidosis is formed.

Causes of acid-base imbalance

Most often, acids accumulate in metabolic disorders. For example, with renal failure, diabetes mellitus or thyrotoxicosis. It can also happen due to malnutrition when there is an insufficient amount of carbohydrates and an excess of fats in food, during starvation or long-term use of low-carbohydrate diets, as well as after taking certain drugs, for example, salicylates and drugs containing. diarrhea and other digestive disorders.

Less common is the so-called respiratory acidosis, which occurs due to circulatory failure and dysfunction respiratory system. This leads to the accumulation of carbon dioxide in the blood. The reason for this may also be a long stay of a person in a closed room without ventilation.

Symptoms that can identify acidosis

Even mothers of small children need to know what it is, because this condition is especially difficult for them. Lack of neutralization of acids leads to headaches, lethargy, sleep disturbances and low blood pressure. Frequent constipation

or diarrhea and vomiting. With acidosis, there is an increase in breathing, a sour or chemical smell from the mouth and from the skin. The accumulation of acids in tissues can lead to gastritis and ulcers, intestinal inflammation and cystitis. The secretion of acidic sweat causes eczema and other skin conditions such as cellulitis. Arthritis or gout develops due to the accumulation of salts in the joints. Severe cases can lead to central nervous system depression and coma.

How to prevent acidosis?

What is it that everyone, even a healthy person, needs to know. After all, very often women's passion for diets and starvation leads to acidosis. And in children, it can appear due to malnutrition, for example, pastries, fast food and the lack of fresh vegetables and fruits in the diet.

Acidosis can also appear due to prolonged physical exertion or oxygen starvation. Therefore, in order for a healthy person to prevent this condition, you need to monitor your diet, walk more in the fresh air and give up bad habits. The diet should be dominated by raw plant foods. It is necessary to abandon sausages, animal fats, confectionery and canned foods. Drink as much fresh water as possible. And to quickly relieve the symptoms of acid poisoning, you can drink a solution of soda.

Acidosis is a state of the body characterized by a violation of the acid-base balance of the body with a shift towards an increase in acidity and a decrease in the pH of its environments. The main reason for the development of the condition is the accumulation of products of oxidation of organic acids, which are normally quickly excreted from the body. An increase in the concentration of organic acid oxidation products during acidosis may be due to external factors(breathing air with a high concentration of carbon dioxide), as well as internal factors, which are violations of the functioning of systems, as a result of which the metabolism of products and the accumulation of metabolites of organic acids are disturbed. Severe conditions with acidosis provoke shock, coma and death of the patient.

Acidosis of any genesis can lead to critical conditions of the body:

• Dehydration;
• Increased blood clotting;
• Critical fluctuations in blood pressure;
• Myocardial infarction, heart attacks of parenchymal organs;
• Decrease in the volume of circulating blood;
• peripheral thrombosis;
• Impaired brain function;
• Coma;
• Fatal outcome.

Classification of acidosis

According to the mechanisms of development of acidosis, the following types of disorders are distinguished:

• Respiratory acidosis (breathing air with a high concentration of carbon dioxide);
• Mixed type of acidosis (a condition caused by various types acidosis).

Non-respiratory acidosis, in turn, is subject to the following classification:

• Excretory acidosis - a condition that develops when there is a violation of the function of removing acids from the body (impaired kidney function);
• Metabolic acidosis is the most complex condition characterized by the accumulation of endogenous acids in body tissues;
• Exogenous acidosis is a state of increasing the concentration of acids, due to the intake of a large amount of substances into the body that are converted into acids in the process of metabolism.

According to the pH level, acidosis is classified as:

• Compensated;
• Subcompensated;
• Decompensated.

When the pH level reaches the limiting minimum (7.24) and maximum (7.45) values ​​(normal pH = 7.25 - 7.44), proteins are denatured, cells are destroyed, enzyme function is reduced, which can lead to the death of the organism.

Acidosis: causes of the development of the disease

Acidosis is not a disease. This is a state of the body, which is caused by the influence of certain factors. With acidosis, the following factors can become the causes of the development of this condition:

• Starvation, diet, alcohol abuse, smoking;
• Poisoning, loss of appetite, other disorders of the functioning of the gastrointestinal tract;
• Body conditions in which metabolism is disturbed (diabetes mellitus, circulatory failure, feverish conditions);
• Pregnancy;
• Malignant neoplasms;
• Dehydration of the body;
• kidney failure;
• Poisoning by substances whose metabolism in the body leads to the formation of excess acids;
• Hypoglycemia (low blood glucose levels);
• Oxygen starvation (in states of shock, anemia, heart failure);
• Loss of bicarbonate by the kidneys;
• The use of a certain number of drugs (salicylates, calcium chloride and others.);
• Respiratory failure.

In some cases, with acidosis, there are no reasons that clearly indicate the development of the condition.

Acidosis: symptoms, clinical picture of the disease

With acidosis symptoms are difficult to differentiate from symptoms of other diseases. In mild forms of acidosis, the symptoms are not associated with a shift in the acid-base balance of the body. The main symptoms of acidosis are:

• short-term nausea, vomiting;
• General malaise;
• Increased heart rate, shortness of breath;
• cardiac arrhythmias;
• Increased blood pressure;
• Disorder of the functions of the central nervous system (drowsiness, confusion, dizziness, loss of consciousness, lethargy);
• shock conditions;

It should be noted that in mild forms of acidosis, symptoms may not appear at all.

Diagnosis of acidosis

For accurate diagnosis of acidosis, the following research methods are used:

• Analysis of the gas composition of the blood (for the analysis, arterial blood is taken from the radial artery on the wrist, a venous blood test will not accurately determine the pH level);
• Analysis of the pH level in the urine;
• Analysis of arterial blood for serum electrolytes.

Blood tests for the main indicators of metabolism (gas composition and serum electrolyte levels) show not only the presence of acidosis, but also determine the type of acidosis (respiratory, metabolic). Other studies may be needed to determine the cause of acidosis.

Acidosis: treatment

Based on the fact that given state due to impaired functioning of body systems, with acidosis, treatment is reduced to the treatment of the underlying disease, pathological condition or dysfunctions that provoked a shift in the acid-base balance of the body.

To correct metabolic acidosis, treatment involves intravenous fluids, as well as treatment of the underlying disease that caused the condition.

At severe forms acidosis treatment involves the appointment of drugs containing sodium bicarbonate (drinking, infusion solutions) to increase the pH to a value of 7.2 and above. Sodium bicarbonate is added to either glucose or sodium chloride solutions, depending on volume disturbances due to acidosis.

For the relief of pronounced ailments in acidosis, symptomatic treatment is prescribed. With the development of acidosis due to poisoning, treatment involves the removal of a toxic substance from the body, in cases of severe poisoning, dialysis is used.

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What is Acidosis

Acidosis(from lat. 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). Usually these products are quickly removed from the body. With febrile illnesses, intestinal disorders, pregnancy, starvation, etc., they linger 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, in diabetes mellitus) it can lead to to a coma.

What causes acidosis

Usually, the products of oxidation of organic acids are quickly removed from the body. With febrile illnesses, intestinal disorders, pregnancy, starvation, etc., they linger 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 coma.

Pathogenesis (what happens?) during Acidosis

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

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

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

Symptoms of Acidosis

The main symptoms of acidosis are often masked by manifestations of the underlying disease or are difficult to distinguish from them.

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 is below 7.35, and the HCO3 concentration is below 21 mEq/L. In the absence of lung diseases partial pressure of carbon dioxide in arterial blood does not reach 40 mm Hg. Art. With simple metabolic acidosis, it can decrease by about 1-1.3 mm Hg. Art. for each mEq/L decrease in plasma HCO3 levels. A greater fall in paCO2 indicates concurrent primary respiratory alkalosis.

Many forms of metabolic acidosis are characterized by growth of undetectable anions. The amount of undetectable serum anions (sometimes called the anion gap or anion deficiency) is estimated from the difference between the serum sodium concentration and the sum of chloride and bicarbonate concentrations.

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 a normal amount of undetectable anions (hyperchloremic metabolic acidosis) is usually due to primary loss of bicarbonate through the gastrointestinal tract or kidneys (eg, in renal tubular acidosis).

diabetic acidosis usually characterized by hyperglycemia and ketonemia. With hyperglycemia and non-ketone (according to conventional clinical analyzes) acidosis increased blood levels of lactic and / or p-hydroxybutyric acid.

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

Salicylates poisoning characterized initially 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 noted (blood urea nitrogen content 30-60 mg%). A more significant increase in blood urea nitrogen, especially in combination with hypocalcemia and hyperphosphatemia, indicates renal failure as the cause of acidosis. Hypocalcemia is sometimes observed in septic shock. Changes in serum potassium levels in acidosis have been discussed above (see potassium metabolism disorders). In lactic acidosis, hyperkalemia is relatively rare unless there is concomitant 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 water.

Which Doctors Should You See If You Have Acidosis

Therapist

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Causes of lactic acidosis

Most often, lactic acidosis develops in type 2 diabetes mellitus in patients who, against the background of the underlying disease, suffered a myocardial infarction or stroke.

The main reasons that contribute to the development of lactic acidosis in the body are the following:

• oxygen starvation of tissues and organs of the body;
• development of anemia;
• bleeding leading to large blood loss;
• severe liver damage;
• the presence of renal failure that develops while taking metformin, if the first symptom from the specified list is present;
• high and excessive physical exercise on the body;
• the occurrence of shock or sepsis;
• cardiac arrest;
• the presence in the body of uncontrolled diabetes mellitus and in the event that a diabetic hypoglycemic drug is taken;
• the presence in the body of some diabetic complications.

The occurrence of pathology can be diagnosed in healthy people due to the impact on the human body of certain conditions and in patients with diabetes mellitus.

Most often, lactic acidosis develops in diabetics against the background of an uncontrolled course of diabetes mellitus.

For a diabetic, this state of the body is extremely undesirable and dangerous, since in this situation lactic acid coma can develop.

Lactic acid coma can be fatal.

Symptoms and signs of complications

In lactic acidosis in diabetes, the symptoms and signs may be as follows:

• disturbance of consciousness;
• the appearance of a feeling of dizziness;
• loss of consciousness;
• the appearance of a feeling of nausea;
• the appearance of the urge to vomit and the vomiting itself;
• frequent and deep breathing;
• appearance pain in a stomach;
• the appearance of severe weakness throughout the body;
• decreased motor activity;
• development of deep lactic acid coma.

If a person has a second type of diabetes mellitus, then falling into a lactic acid coma is observed some time after the first signs of a complication appear.

When the patient falls into a coma, he has:

1. hyperventilation;
2. increased glycemia;
3. a decrease in the amount of bicarbonates in the blood plasma and a decrease in blood pH;
4. in the composition of urine, a small amount of ketones is detected;
5. the level of lactic acid in the patient's body rises to 6.0 mmol/L.

The development of the complication is quite acute and the condition of a person with type 2 diabetes mellitus worsens gradually over several hours in a row.

The symptoms accompanying the development of this complication are similar to the symptoms of other complications, and a patient with diabetes mellitus is able to fall into a coma state both with reduced and with elevated level sugar content in the body.

The whole diagnosis of lactic acidosis is based on a laboratory blood test.

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What is lactic acidosis?

This is rare, but very dangerous syndrome(or complication), which occurs with increased accumulation of lactic acid (LA) in the blood, and acidosis is accompanied by a large anion gap.

Normally, there is a slight production of UA daily, formed through metabolism. It is almost immediately utilized with the formation of lactate. This substance is converted in the liver by oxidation into several compounds or substances such as CO2 (carbon dioxide) and water or (depending on needs) into glucose with the regeneration of HCO3- (bicarbonate).

If it accumulates a large number of lactic acid, then, accordingly, the output of lactate is disturbed. This leads to lactic acidosis.

The reasons

Usually lactic acidosis is manifested in seriously ill people who not only have type 2 diabetes, but also suffered a myocardial infarction, stroke.

Main features:

• tissue hypoxia (in other words, lack of oxygen or oxygen starvation)
• anemia (anemia)
• profuse bleeding due to hemorrhage
• severe liver damage
• indirectly - kidney failure against the background of taking metformin in the presence of the first sign from the list
• shock or sepsis
• heart failure
• carbon monoxide poisoning
• severe form of acidosis
• uncontrolled diabetes mellitus in the crowd with the intake of hypoglycemic drugs and some existing diabetic complications

Symptoms and signs

To characterize the patient's condition in the presence of this syndrome, it should be understood that this is a rare complication and is more common in people with numerous problems with health (more often for older people with advanced diabetes with existing liver failure).

It proceeds quite sharply and the patient's condition worsens within a few hours.

Usually a person feels and experiences the following sensations:

• disturbance of consciousness
• clouding of mind
• dizziness
• loss of consciousness
• nausea
• vomit
• frequent deep breathing
• abdominal pain
• severe weakness throughout the body
• there is a decrease in motor activity
• deep lactic acid coma (a person falls into a coma only after some time in the presence of the above symptoms)

This results in:

• hyperventilation
• moderately elevated glycemia (typical for diabetes and rarely exceeds critical levels)
• decrease in plasma bicarbonates and its pH (the level of CO2 in the blood falls)
• the presence of ketones in the blood is negative, and in the urine there is a small amount of them (only under the condition of prolonged fasting)
• hyperphosphatemia (when azotemia is negative)
• the level of lactic acid exceeds the value of 6.0 mmol / l - an absolute diagnostic criterion

If you look at the above symptoms, most of these signs can be prescribed to other diseases or complications, which, as a rule, develop rapidly. A diabetic can go into a coma reduced level blood sugar, and with increased and the symptoms will be similar. Therefore, the entire diagnosis of lactic acidosis is based primarily on a blood test! If you do not take a sample, then such a decision can cause the death of the patient.

Treatment of lactic acidosis in diabetes mellitus

Since this condition can be provoked primarily by a lack of oxygen, the treatment of lactic acidosis is based on the scheme of saturating the cells and tissues of the body with oxygen through mechanical artificial ventilation of the lungs.

Of course, at the same time, the patient's pressure is necessarily monitored and all his vital signs are monitored. Especially careful monitoring is carried out for older people suffering from arterial hypertension who have liver complications or any other serious health problems.

Before a diagnosis of lactic acidosis is made, the patient will have a blood test to determine the pH level and potassium concentration.

In severe cases, sodium bicarbonate is given, but only if the blood pH is<7.0. Без результатов pH раствор вводить нельзя!

The following solution is usually used: 50 mmol of bicarbonate is dissolved in 200 ml of sterile water with 10 mEq of potassium chloride. Gradually injected over 2 hours. An analogue of the solution can serve as 4 g of bicarbonate in the form of 200 ml of a 2% solution, administered intravenously also slowly and within one hour.

If the pH< 6.9, то в таком случае применяют 100 ммоль бикарбоната, который разводят в 400 мл стерильной воды с 20 мЭкв хлорида калия со скоростью 200 мл/час в течение двух часов (или 8 гр. бикарбоната в виде 400 мл 2%-ного раствора в течение двух часов).

The pH of the venous blood is assessed every 2 hours and bicarbonate is continued until the pH level exceeds 7.0.

If the patient also has acute renal failure, then hemodialysis of the kidneys is used. They may also do peritoneal dialysis to restore normal blood bicarbonate levels.

Of course, in diabetes, adequate insulin therapy is used to correct carbohydrate metabolism. Heparin and reopoliglyukin can be used in small doses.

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Where does excess lactate come from?

Under the action of biochemical catalysts, the glucose molecule decomposes and forms two molecules of pyruvic acid (pyruvate). With a sufficient amount of oxygen, pyruvate becomes the starting material for most of the key metabolic processes of the cell. In the event of oxygen starvation, it turns into lactate. Its small amount is needed by the body, lactate returns to the liver and is converted back into glucose. This forms a strategic store of glycogen.

Normally, the ratio of pyruvate and lactate is 10:1; under the influence of external factors, the balance can shift. There is a life-threatening condition - lactic acidosis.

A critical increase in the level of lactic acid in the body is a condition that requires urgent, immediate hospitalization. Up to 50% of detected cases are fatal!

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Causes of diabetic lactic acidosis

Hyperglycemia leads to the fact that excess sugar in the blood is intensively converted into lactic acid. The lack of insulin affects the conversion of pyruvate - the absence of a natural catalyst leads to an increase in the synthesis of lactate. Persistent decompensation contributes to chronic cell hypoxia, entails a lot of complications (kidneys, liver, cardiovascular system), which aggravate oxygen starvation.

A large proportion of the manifestations of lactic acidosis occurs in persons taking hypoglycemic drugs. Modern biguanides (metformin) do not cause a persistent accumulation of lactic acid in the body, however, if several provoking factors (an infectious disease, trauma, poisoning, alcohol intake, excessive physical activity) occur, they can contribute to a pathological condition.

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Symptoms of lactic acidosis in diabetes

There is drowsiness, weakness, fatigue, heaviness in the limbs, nausea may occur, less often vomiting. Lactic acidosis is dangerous because it develops rapidly in just a few hours. After general diabetic symptoms, diarrhea, vomiting and confusion develop abruptly. At the same time, there are no ketone bodies in the urine, there is no smell of acetone.

If the test strips for visual determination of ketoacidosis and glucose level show only high sugars, while there is muscle pain, you should immediately call an ambulance! If you do not take any action and try to stop the condition on your own, then a coma will follow a sharp decrease in blood pressure, rare and noisy breathing, heart rhythm disturbance.

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Treatment of hyperlactacidemia

It is almost impossible to provide first aid for signs of lactic acidosis. It will not work to reduce the acidity of the blood outside the hospital. Alkaline mineral water and soda solutions will not lead to the desired result. With low blood pressure or shock, the use of dopamine is justified. It is necessary to ensure the maximum flow of air, in the absence of an oxygen bag or inhaler, you can turn on the humidifier and open all the windows.

The prognosis for recovery from lactic acidosis is unfavorable. Even adequate treatment and timely access to doctors do not guarantee life saving. Therefore, diabetics, especially those taking metformin, should carefully listen to their body, keep their sugar levels in the target range.

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Causes of acid-base imbalance

Most often, acids accumulate in metabolic disorders. For example, with renal failure, diabetes mellitus or thyrotoxicosis. This can also happen due to malnutrition, when there is an insufficient amount of carbohydrates and an excess of fat in food, during starvation or long-term use of low-carbohydrate diets, and also after taking certain medications, for example, salicylates and drugs containing ammonium chloride. The lack of alkalis to neutralize acids is due to the loss of sodium bicarbonate by the body during vomiting, diarrhea and other digestive disorders.

Less common is the so-called respiratory acidosis, which occurs due to circulatory failure and dysfunction of the respiratory system. This leads to the accumulation of carbon dioxide in the blood. The reason for this may also be a long stay of a person in a closed room without ventilation.

Symptoms that can identify acidosis

Even mothers of small children need to know what it is, because this condition is especially difficult for them. Lack of neutralization of acids leads to headaches, lethargy, sleep disturbances and low blood pressure. Frequent constipation or diarrhea, loss of appetite and vomiting. With acidosis, there is an increase in breathing, a sour or chemical smell from the mouth and from the skin. The accumulation of acids in tissues can lead to gastritis and ulcers, intestinal inflammation and cystitis. The secretion of acidic sweat causes eczema and other skin conditions such as cellulitis. Arthritis or gout develops due to the accumulation of salts in the joints. Severe cases can lead to central nervous system depression and coma.

How to prevent acidosis?

What is it that everyone, even a healthy person, needs to know. After all, very often women's passion for diets and starvation leads to acidosis. And in children, it can appear due to malnutrition, for example, pastries, fast food and the lack of fresh vegetables and fruits in the diet.

Acidosis can also appear due to prolonged physical exertion or oxygen starvation. Therefore, in order for a healthy person to prevent this condition, you need to monitor your diet, walk more in the fresh air and give up bad habits. The diet should be dominated by raw plant foods. It is necessary to abandon sausages, animal fats, confectionery and canned foods. Drink as much fresh water as possible. And to quickly relieve the symptoms of acid poisoning, you can drink a solution of soda.

A very dangerous condition that can lead to death is acidosis. What it is you need to know in order to avoid severe damage to organs and tissues.

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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 - the accumulation of lactic acid due to alcohol abuse, heavy physical exertion, malignant tumors, hypoglycemia, the use of certain medications, anemia, convulsions, etc.

Metabolic acidosis manifests itself in the following symptoms:

1. A stunned, soporous or inhibited state.
2. Rapid breathing.
3. 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.

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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:

1. Diabetes.
2. epilepsy.
3. Convulsive conditions.
4. Hodgkin's disease.
5. Diseases of the liver and kidneys.
6. Neoplasia.
7. Myelomas.
8. infections.
9. Leukemia.
10. Bacteremia.
11. Generalized lymphoma.

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

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Causes of acidosis

Maintaining a normal acid-base balance is as important as the absence of any infectious diseases. The main causes of acidosis are lifestyle, sedentary day regimen 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 body should not have a metabolic disorder, and there should be no chronic diseases that provoke a latent course of acidosis. These include tumors, allergic reactions, neurosis, rheumatism, tissue inflammation, etc.

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Acidosis symptoms

Acidosis is often manifested by the symptoms that express the main disease. In a mild form, it may not appear 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 disease.

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.
• Depression of the nervous system.

The aggravation of acidosis is accompanied by the appearance of:

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

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acidosis and alkalosis

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 disorders 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 and blood pressure decrease. Violated water and electrolyte balance. The bones lose their hardness, gradually there are changes in the work of the heart.

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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:

1. sodium bicarbonate.
2. Nicotinic acid.
3. Cocarboxylase.
4. Riboflavin mononucleotide.
5. Glutamic acid.
6. 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, vegetable fats, 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.

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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.