Alkalosis and Acidosis

The degree of acidity or alkalinity is an important property of our blood. The acidity level increases with the increase in the level of acidic compounds in our body, or when the level of basic (also known as alkaline) compounds present in our body falls. The alkalinity level in our body increases when the reverse takes place, i.e., when the level of acidic compounds falls or when the basic compounds in the body increase. The acidity or alkalinity of any solution is indicated on the pH scale. Even a minor shift from the normal range can destroy our organs. Generally, the normal acidic level (pH) of our blood is close to 7.4. When the pH level falls below 7.35, then we say that acidosis has occurred. On the other hand, when the pH goes above 7.45, then we say that alkalosis has occurred. We have a severe case of the former, when the pH value of blood goes below 7.0; while a severe case of the latter can occur when the pH value goes above 7.5. Let us now see what are the various causes and problems of acidosis and alkalosis.

Causes

Acidosis

• Certain diseases, like emphysema or kidney failures often reduce the efficiency of the lungs or the kidneys respectively. This reduces their ability to regulate the acidic level in our body.
• If you starve yourself or if you have diabetes, then, by the metabolism of large amounts of body fats, excessive acid is produced.
• Excess protein intake might be a cause.
• Ingestion of a large amount of acidic substances is a major reason.

Alkalosis

• Severe diarrhea causes excessive loss of body fluid. This is a major cause.
• Loss of carbonic acid due to rapid breathing is also another cause.
• Excessive vomiting leads to loss of hydrochloric acid.
• Excessive intake of sodium bicarbonate to relieve the acid in stomach causes temporary metabolic alkalosis.

Health Problems

Two major problems might arise - respiratory and metabolic acidosis and alkalosis. Let us now see what each means.

Acidosis

Respiratory

Causes

When our lungs do not expel the carbon dioxide in adequate amount, a problem which might occur after we have suffered from certain lung infections or diseases, that is when we have this disorder. This can also occur when the diseases of the brain, nerves, or the muscles of the chest create problems in breathing. This problem may also arise when people take in lots of drugs or narcotics, which causes difficulty in breathing.

Symptoms

• Headaches or drowsiness
• Stupor and coma
• Problems in breathing

Treatment

Functioning of the lungs has to be improved. For people who are suffering from lung diseases, drugs are given to them to open the airways so that air can pass freely. Sometimes, mechanical ventilation are also needed to help in the breathing process.

Metabolic

Causes

It usually occurs when the acid level in our blood increases due to ingestion of a substance that contains acid, or that can be broken down into acid. It may also occur due to abnormal metabolism. Also, if the kidneys are not in a proper working condition, then even normal production of acid, cannot be excreted through urine.

Symptoms

• Nausea, vomiting, and fatigue are common.
• Body tries to correct the acid level by producing more of carbon dioxide, hence breathing becomes slightly faster.
• In severe cases, people feel weak, drowsy, and confused.
• They also become extremely nauseated
• Blood pressure may fall, which leads to shock, coma, or even death.

Treatment

Treatment depends upon the cause. If diabetes is the cause, then there will be a need to control it with the use of insulin. If there is poisoning, then the treatment is to remove the toxin from the blood.

Alkalosis

Respiratory

Causes

Too much anxiety often leads to hyperventilation or deep breathing, which releases too much carbon dioxide into our blood stream. The other causes, which lead to hyperventilation are pain, less oxygen in our blood, fever, overdose of aspirins or drugs, etc.

Treatment

The rate of breathing has to be slowed down. The patient is asked to breathe in and out into a paper bag (and not a plastic bag). Breathing in and out the carbon dioxide helps raise the level of the same in the blood.

Metabolic

Causes

When our body either gains too much base or loses too much acid, then we have this problem. It also occurs if a person has ingested too much base from a substance.

Treatment

There are various diagnostic tests, which are carried out by the doctors. They usually treat by giving dilute acid.

Symptoms

The symptoms of both the problems are as follows:

• Irritability
• Muscle twitching and cramps
• Prolonged contraction of muscles (in severe cases)

So, there you have the causes, problems, symptoms, and various treatments. So, if you are facing any problems or showing any signs of the same, go to a doctor immediately before your condition worsens.

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Metabolic Acidosis Vs. Respiratory Acidosis

Increase in the acid content in the body is referred to as acidosis. It mainly occurs when the pH level falls below 7.35. There are two kinds of acidosis, respiratory acidosis and metabolic acidosis. These clinical disturbances can have several effects on the body, ranging from minor to severe. Let's find out about both these disorders by going over the following information.

Metabolic Acidosis

• Metabolic acidosis is another type of medical condition called acidosis, where the production of H^ is increased. This increase in hydrogen ions in the blood is known as academia. The body may also be unable to form bicarbonate in the kidney. These disturbances in the acid base content can lead to this ailment.
• Chronic renal failure, diabetic ketoacidosis and kidney failure also contribute to this condition to some extent. Swallowing toxic substances, like excessive amount of aspirin, can also cause the disease.
• It can either be mild or chronic.
• The symptoms are lethargy and rapid breathing.
• At the minor level, baking soda can be used for maintaining the acid base level.
• A complete blood count test is done to diagnose the condition. Another test is metabolic panel test which help to know the severity and cause of the condition. For knowing the severity, the patient can also be asked to take arterial blood gas test. If proper treatment is not taken at proper time, then the condition can prove fatal.
• In order to be away from metabolic acidosis, the only way is to keep away from Type 1 diabetes.

Respiratory Acidosis

• Respiratory acidosis is a type of condition, wherein the respiration is decreased leading to increased amounts of carbon dioxide in the blood.
• Abrupt ventilation failure can cause this condition. Alveolar hypoventilation can be another cause of it.
• It can either be acute and chronic. Acute respiratory acidosis occurs if there is an abrupt ventilation failure. While, chronic respiratory acidosis takes place, if the level of PaCO2 rises above the range of permissible upper limit.
• The symptoms are fatigue, confusion, lethargy, sleepiness and shortness of breath.
• Depending on the severity, different treatments are available. The patient may be prescribed bronchodilator drugs, for reversing airway obstruction. If the amount of oxygen in the blood is low, then the patient can opt for treatments which will help in increasing it. If required, mechanical ventilation or non-invasive positive pressure ventilation is another treatment option.
• The tests that are done to know the severity and causes are pulmonary function test, chest X-ray and arterial blood gas test.
• The different preventive measures that you can opt for are maintaining balanced weight and controlling obesity. Avoiding smoking and consumption of alcohol will also help.

Hope this a brief overview has been helpful. Knowing the causes and symptoms of these two disorders, one can take preventive measures. Like its said, forewarned is forearmed!

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Symptoms, Causes and Treatment of Metabolic Acidosis

Metabolic acidosis refers to the condition where the acid-base balance of the body is disrupted due to an increased production of acid or the reduced excretion and decreased production of bicarbonates. The condition can ultimately lead to acidemia or acidity of blood, where arterial pH falls below 7.35. If this condition is left untreated, it can affect the central nervous system and lead to coma and even death.

Causes

Metabolic acidosis is caused by an increase in the level of acids due to increased acid production or ingestion of acids or substances that can be converted into acids. It can also be caused by:

• Loss of bicarbonates as in the case of diarrhea and renal tubular acidosis.
• Ingestion of substances like large amounts of antifreeze, aspirin, etc. can also increase the level of acid within our body.
• Accumulation of lactic acid is another contributory factor. It usually takes place due to insufficient availability of oxygen in carbohydrate metabolism, as in the cases of heart failure and shock.
• Malaria can also be responsible for this condition by destroying the red blood cells and thereby reducing the level of oxygen in the body. This in turn results in the accumulation of lactic acid due to anaerobic breakdown of glucose or carbohydrates. This type of acidosis is known as lactic acidosis.
• Metabolic abnormalities can lead to acidosis. Use of fat instead of carbohydrates, for deriving energy, as in the case of diabetes mellitus, can lead to an excessive production of acids. Breakdown of fats produces ketones and raises the level of acids in the body. This condition is termed as diabetic ketoacidosis.
• Sometimes, such a pH imbalance can occur even without the excessive production of acids. For instance, in case of people suffering from kidney failure, kidneys may fail to excrete acids through urine.
• Conditions like alcoholism and malnutrition are also associated with this condition.

Symptoms

Though metabolic acidosis is usually characterized by rapid breathing, the symptoms may not be specific, and could vary depending on the underlying cause. However, some of the common symptoms are:

• Chest pain, headaches, palpitations, muscle and bone pain, muscle weakness, abdominal pain, etc.
• Lactic acidosis is sometimes characterized by low blood pressure and anemia.
• In diabetic ketoacidosis, patients may suffer from elevated blood sugar level and dehydration. As this condition can affect the central nervous system, individuals may experience anxiety and progressive drowsiness. Nausea, vomiting, loss of appetite, and weight loss are some other symptoms.
• In extreme conditions, it can cause severe complications like stupor, coma, and seizures.

Treatment

Physicians generally carry out blood tests like arterial blood gas analysis and a complete count of blood cells to diagnose the condition. The treatment depends on the underlying causes. However, if the blood pH falls below 7.1, the condition can require the administration of bicarbonates intravenously to neutralize the acids. In severe cases, dialysis may be required. Mechanical ventilation is also employed to ease breathing problems.

Monitoring and controlling the factors responsible for causing this condition is the best way to prevent the condition from worsening. As for example, controlling the underlying causes like diabetes can help control the disease in diabetic patients. Metabolic acidosis is often a symptom of some serious diseases like renal and heart failure and diabetes. So the proper monitoring of the symptoms of this condition would be of great help in preventing any complications.

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Symptoms, Causes, and Treatment of Lactic Acidosis

Lactate is a by-product formed when glucose is broken down aerobically by the cell's mitochondria - the power house of the cell. When the body or a region of the body is deprived of oxygen, it leads to tissue hypoxia. This results in anaerobic breakdown of the glucose in the cells. The end product of this reaction is lactic acid. The blood pH becomes too acidic due to presence of excess lactic acid in the tissues. Thus, leading to lactic acidosis, a rare condition. People who suffer from this condition may develop serious complications, especially when they suffer from certain risk factors. In extreme cases, it may also lead to death.

The body generates most of its energy aerobically, that is, by using oxygen. Under normal circumstances, the cells break down glucose by a process called glycolysis, to generate pyruvate, which is further broken down by an aerobic pathway for more energy. However, under certain conditions, like trying to outrun a hungry lion or pumping iron to increase triceps and biceps, our body requires more energy. The requirement of energy becomes inversely proportional to the body's capacity to deliver the required amount of oxygen. Thus, pyruvate is converted to lactate, which allows glucose production and energy is produced. Within one or two minutes the lactic acid level increases in the blood. Thus, leading to this condition that occurs due to buildup of lactic acid in the muscles and blood. Most of the time after a strenuous exercise, running or due to some other activity, one may develop mild to moderate lactic acidosis. This condition is not very serious and may resolve on its own. However, if one experiences extreme pain and discomfort and develops this condition frequently, then doctors attention is a must. We shall have a look at lactic acidosis symptoms, causes, and treatment in this Buzzle article to know more about this condition.

Symptoms

When there is excess of lactic acid in the body, the muscular as well as cardiac activity becomes very difficult. The heart starts beating fast, the muscles begin to hurt and one experiences a burning sensation in the muscles. Other symptoms include:

• Nausea
• Vomiting
• Abdominal pain
• Lethargy
• Abnormal breathing
• Low blood pressure
• Irregular heart rhythm

Causes
It may be the result of several underlying medical conditions. They include:

• Genetic disorders like mitochondrial encephalomyopathy, glycogen storage disease, fructose 1,6-diphosphatase deficiency, pyruvate dehydrogenase deficiency
• Kidney diseases
• Diabetic nephropathy
• Heart diseases
• Lung diseases like decrease in oxygen intake
• Drugs like phenformin, metformin, also cause this condition

Other causes include hypoxia, hemorrhage, liver disease, shock, sepsis, Non-Hodgkin's and Burkitt lymphoma. In some people, hemorrhage, ethanol toxicity, shock, diabetic ketoacidosis, sepsis may also lead to it. It may even occur due to lack of vitamin B1 (thiamine) deficiency in the body.

People suffering from type 2 diabetes are often prescribed metformin hydrochloride. This drug is also called Glucophage that is taken orally to control the levels of sugar in blood. According to the Food and Drug Administration (FDA), about 3 in every 100,000 people prescribed this drug are at risk of developing lactic acidosis over a one-year period. The risk increases in people suffering from congestive heart failure, decreased kidney function and other risk factors. Diabetics taking this drug may show signs of this health problem that includes weakness, sleepiness, cold feeling in body, shortness of pain, stomach pain, lightheadedness, pain in muscles, decrease in heart rate, and may even faint. If one does suffer from some or most of these signs, they should contact their doctor immediately. They may be asked to stop using this drug to prevent a serious complication.

In some children, it occurs due to a rare congenital disease where the cells do not convert pyruvate into carbon dioxide and water. When such children get engaged in any physical activity, their body breaks down more glucose and pyruvate gets accumulated. The cells do not oxidize the accumulated pyruvate resulting in an increase in lactic acid level. This in turn leads to lactic acidosis. Diabetics and people with stomach ulcers often complain of it.

Apart from these underlying conditions, it is also caused if a person reaches the anaerobic threshold or lactate threshold. This is the upper limit of the ability of an individual's body to exercise. When a person exercises at a limit below the lactate threshold, very little lactic acid will be produced. Thus, the liver will be able to get rid of the excess present. However, if the person crosses their threshold limit, it leads to glucose inefficiency. This means, the muscles undergo an alternative reaction and start producing lactic acid. This new product begins to build up in the blood and muscles leading to the symptoms.

Treatment

• Sodium bicarbonate, an alkaline to neutralize the acid, can be administered intravenously. This therapeutic treatment should be used sparingly as it can lead to serious complications.
• Sodium nitroprusside, by the method of alleviating regional hypoperfusion, has been suggested for the treatment of some forms of lactic acidosis.
• Peritoneal dialysis and hemodialysis can be used sometimes for cleansing the blood of lactic acid.
• Insulin therapy is very useful in phenformin associated lactic acidosis.
• Dichloroacetate can also be a useful adjunct in the treatment.

The latest treatments are:

• Early Intubation
• Thimine
• Naloxone
• I.V. Fluids

Suggestions

• It is extremely important to keep a watch on your diet. One should reduce the intake of beef, pork, junk food, and animal proteins.
• Excessive intake of Vitamin C also increases the chances of acidosis.
• Beans, cereals, crackers, eggs, flour products, grains, oily food and sugar should be used sparingly.
• Prunes, cranberries, and plums form acid and remain in the body which increases lactic acid levels in the blood. Therefore, limit the intake of these fruits in your diet.
• Vitamin A, vitamin B and potassium help in keeping the levels of lactic acid in check.
• Citrus fruits do not increase the acidic level of the blood, instead they are converted to carbon dioxide and water and have an alkaline effect on the body.

Lactic acidosis is a dangerous condition. Consult your doctor if you suspect this health problem. If a specific medication has been advised, do not stop taking your medication. Also, if you suspect certain prescribed drugs may be the reason behind the possible symptoms, speak to your doctor before you stop the medication. It's always better to remain alert when it concerns your health. As the old saying goes, 'Health is Wealth'!

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Symptoms, Causes and Treatment of Renal Tubular Acidosis

The process of breaking down of food in the body produces acids. These acids circulate in the blood, and it is the function of the kidneys to remove the excess acid from the blood and excrete it through urine. This filtration task is mainly done by the tubules of the nephron, which is the functional unit of the kidneys. There are around 800,000 to one million nephrons in a human kidney. In people affected with renal tubular acidosis (RTA), this function of the kidneys gets impaired, due to various reasons. This condition results in a rise in the acid content of the blood. The high levels of acid in blood is called metabolic acidosis, but RTA specifically refers to the condition in which the kidneys fail to remove the acids and expel them from the body, through urine.

Type 1 or Distal RTA

Type 1 or Distal RTA is the most common form of this medical condition. Distal RTA is characterized by malfunctioning of the cells of the distal (distant) nephron, thereby making the blood acidic. Those with this condition have high levels of acid and low levels of potassium in the blood, calcium deposits in the kidneys causing kidney stones, and low level of minerals in the bones, leading to rickets in children and osteomalacia in adults. Distal renal tubular acidosis can also cause dehydration, weakness of muscles, paralysis, and kidney failure. Since the disease is caused by the impairment of distal nephron, it is named distal RTA.

The symptoms may vary from person to person, and some of them may not experience any sign of the disease. The symptoms include severe rickets in children, loin pain, and hematuria (red blood cells in urine) caused by kidney stones. Sometimes, distal RTA may lead to renal failure and death. Distal RTA can be caused by autoimmune diseases like Sjögren's syndrome, rheumatoid arthritis, systemic lupus erythematosus, and hypergammaglobulinemia. In such cases, renal tubular acidosis can lead to severe hypokalemia.

Distal RTA can be hereditary too. If linked to heredity, the disease may be associated with hypokalemia and sensorineural deafness. The other causes include liver cirrhosis, sickle cell anemia, chronic urinary tract obstruction, and renal transplantation. The treatment for distal RTA includes oral sodium bicarbonate or sodium citrate (alkaline agents), for normalizing acid levels in the blood. This helps to fight bone demineralisation too. Hypokalemia, urinary stones, and calcium deposits are treated with potassium citrate.

Type 2 or Proximal RTA

This type is caused by malfunctioning of the proximal (meaning 'near') tubular cells. These cells fail to reabsorb filtered bicarbonate from the urine. Bicarbonate neutralizes acid in the blood. As the kidneys fail to retain bicarbonate, the levels of acid in the blood increases. The bicarbonate levels of the urine also rises. This form is not as severe as the distal RTA, because in this case, the distal intercalated cells function normally. Proximal RTA is mainly caused due to the malfunctioning of the proximal tubular cells, which is termed Fanconi's syndrome. This condition is characterized by demineralization of bones causing rickets or osteomalacia.

The other causes of proximal RTA include hereditary disorders, like Lowe syndrome, Wilson's disease, cystinosis, glycogen storage disease (type I), and galactosemia. This disease can be a result of acquired disorders, like multiple myeloma, toxins like lead and cadmium, and amyloidosis. Proximal renal tubular acidosis is mainly treated with oral bicarbonate. This compensates the loss of bicarbonates through urine, but the amount of bicarbonate supplements should be large enough to reverse the high acid content of the blood and bone demineralization.

Type 4 or Hyperkalemic RTA

Type 4 RTA is caused by low levels of the hormone aldosterone (hypoaldosteronism), which directs the kidneys to regulate the levels of sodium, potassium, and chloride in the blood. The kidneys excrete excess amounts of sodium, potassium, and chloride, through urine. It may also be caused when the kidneys do not respond to this hormone. Hyperkalemic RTA is characterized by high levels of potassium in the blood or hyperkalemia. One of the causes of this type of renal tubular acidosis is deficiency of aldosterone due to malfunctioning of the adrenal glands, congenital adrenal hyperplasia, or aldosterone synthase deficiency.

Another cause is hyporeninemic hypoaldosteronism, a condition that develops due to diseases, like HIV and renal dysfunctioning; or use of drugs, like NSAIDs and ACE inhibitors. In some people, aldosterone resistance is the reason for Type 4 RTA. This may be caused by some drugs or by pseudohypoaldosteronism. Symptoms are very rare in this type of RTA. If the level of potassium in the blood is very high, irregular heartbeats, and muscle paralysis may occur. The treatment for this form of RTA includes mineralocorticoid for aldosterone deficiency and fludrocortisone for hyporeninemic hypoaldosteronism.

Type 3 RTA, which is now considered as a combined form of Type 1 (Distal) and Type 2 (Proximal) RTA, was earlier recognized as a distinct form of this disease. Type 3 RTA was commonly found in infants and kids, and was known as 'Juvenile RTA'. This type of renal tubular acidosis is very rare.

If RTA is treated properly, kidney failure can be averted. Ultimate goal of any treatment plan for RTA is neutralization of acid in the blood. If the acid is not neutralized, it can lead to complications, like kidney stones, bone diseases, growth retardation, chronic kidney disease, and kidney failure.

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Acidosis Symptoms

Acidosis refers to an abnormal increase in the acidity (excessively low pH) of the body fluids, resulting from excess acids or decrease in bicarbonates. It is classified into respiratory acidosis, and metabolic acidosis, which is further categorized into lactic acidosis, diabetic acidosis, and hyperchloremic acidosis. The symptoms of each of these types have been provided below.

Respiratory Acidosis

Inability of the lungs to expel carbon dioxide leads to its accumulation in the body fluids, thereby causing respiratory acidosis. This leads to confusion, fatigue, shortness of breath, lethargy, and sleepiness. Persistent drowsiness may progress to stupor or coma. To confirm the diagnosis, chest X rays, pulmonary function tests, and assessment of arterial blood gas, are recommended.

Metabolic Acidosis

Alterations in the metabolic processes of the body may lead to an excess amount of acids in the body. The symptoms of different types of metabolic acidosis have been provided below.

Lactic acidosis is characterized by a buildup of lactic acid in the body fluids and tissues, due to liver failure, hypoglycemia, cancer, prolonged exercise, and certain medications. The symptoms manifested are nausea, vomiting, lethargy, severe anemia, low blood pressure, abnormal breathing, abdominal pain, and irregular heartbeat. The condition is confirmed by assessing the electrolyte levels in blood.

Diabetic acidosis, also known as diabetic ketoacidosis, arises due to an excessive fat metabolism followed by a buildup of ketone bodies. The symptoms include dry skin and mouth, rapid breathing, flushed face, headache, poor appetite, stomach ache, fruity odor of breath, nausea, vomiting, and muscle aches. In certain cases individuals may experience frequent urination, stupor, and difficulty in breathing while lying down.

Hyperchloremic acidosis is the result of excessive loss of sodium bicarbonate from the body. This leads to constriction of blood vessels in the kidneys, and altered glomerular filtration rate. Symptoms indicating altered renal function may be observed.

The precise treatment option depends on the underlying etiology. In respiratory acidosis, the treatment focuses on improving lung function. People suffering from lung diseases may be prescribed with medications to clear the blocked airways. Other than treating the underlying cause, mild cases of acidosis may be treated directly with the administration of oral or intravenous fluids. Symptomatic treatments that focus on restoring the electrolyte balance and pH balance of the body fluids, are recommended. In case of any symptoms suggestive of acidosis, it is advisable to consult the appropriate professional, and undergo the necessary diagnostic tests.

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