Acidosis and alkalosis are conditions in which there is a disturbance in the pH balance (acid-base balance) of the body. Acidosis is a condition in which the bodily fluids become too acidic, with an abnormally low pH level. In alkalosis, the opposite is true: the fluids of the body are too alkaline (high in pH). pH is a way of measuring the acidity or alkalinity of a fluid, on a scale from 1 to 14. A pH of 7 is considered neutral, while 1 is extremely acidic, and 14 is extremely alkaline, which is sometimes called “basic”. Normally, the pH of the human body is around 7.4, which is slightly higher than the chemically-neutral pH of 7. This slightly alkaline pH is ideal for many crucial processes that take place continually in the human
body. For instance, normal pH and proper acid-base balance enables the right amount of oxygen to enter and circulate in the blood, moving oxygen to all the cells and tissues of the body. Proteins, including enzymes, which speed up many chemical actions in the body, can’t function normally if body fluids are too acidic. Acidosis occurs when bodily fluids contain too much acid. This results in a decrease in blood pH, since
lower numbers represent more acidic substances. The blood is considered to be abnormally acidic (high in acid) when its pH is lower than 7.35. Mild acidosis may be present without causing symptoms. In some cases, especially in seriously ill people, it can worsen if it is not diagnosed and treated. Acidosis can sometimes lead to serious physical effects, such a: Alkalosis is a condition in which the blood has too little acid, making it too alkaline or basic, which is another term for alkaline. This results in a higher blood pH, as higher numbers represent more alkaline substances. The blood is considered to be abnormally alkaline when its pH is above 7.45. Mild, longstanding (chronic)
alkalosis may occur without noticeable symptoms. Alkalosis that causes severe or rapid pH changes is more likely to cause symptoms that can include: The normal pH of the human body ranges from 7.35 to 7.45, with 7.4 being average. The body constantly engages in a number of activities to maintain pH within this narrow range. Under normal circumstances, the level of acids and bases in the body may rise and fall, as more acids and bases are produced or
taken in. Processes in the body are always at work to adjust for these changes and keep the acid-base balance within the normal range. Our bodies constantly produce acids during the normal processes of metabolism. Metabolism means all of the chemical and physical processes that our bodies use to generate energy and to produce substances necessary to maintain life. For example, our bodies convert nutrients in our food like fats,
carbohydrates, and proteins into energy. The processes of metabolism normally generate large quantities of acids during these ongoing activities. Most of the acid in our bodies is carbonic acid. The metabolism of fats and carbohydrates generates carbon dioxide which combines with water in the body to form
carbonic acid. Other acids produced by the body include: Specialized cells in the brain and blood
vessels sense the body’s acidity, and control processes that neutralize and remove acids. This feedback loop is essential to maintaining the body’s acid-base balance. Maintaining balance is crucial because even small changes can severely affect many organs and disrupt the way the cells of the body function. The different mechanisms that the body uses to continually neutralize and remove acids and maintain pH balance include: The body automatically adjusts when
it notices an imbalance in pH. The mechanisms it uses push the acid-base balance back toward the ideal pH range. The main organs involved in these processes are the lungs and the kidneys. The lungs respiratory system responds to changes in acid-base balance caused by the body’s metabolic processes. Carbon dioxide, when combined with water, forms an acid (carbonic acid). When you breathe out, carbon dioxide
is removed from your body into the environment and your body removes acids that have been produced by metabolism. Your respiratory system automatically adjusts your breathing rate and the amount of air that moves out of the lungs. This ensures you exhale the right amount of carbon dioxide based on how much acid your tissues are producing. For example, in diabetic ketoacidosis, low levels of
insulin force the body to break down fats for energy use, in place of using glucose that requires insulin. Breakdown of fat produces excess
ketoacids, which lower the body’s pH. The breathing rate increases to get rid of carbon dioxide. When carbon dioxide is removed from the body at a faster rate, the level of acid in the body drops, and the pH starts to return toward the normal range. The lungs also can also adjust when blood pH is too high. For example, if someone loses stomach
acid due to vomiting, the blood pH can rise. The breathing rate will slow and less carbon dioxide will be removed through breathing. This drives the body’s pH lower, toward the normal range. Your kidneys also play a critical role in maintaining your body’s pH. Generally, the kidneys respond with acid-base imbalances from conditions that affect the lungs. The kidneys help maintain normal
pH balance by increasing the amount of acid released in the urine when the body’s pH level is too low (acidic), and retaining bicarbonate, which is a base (alkaline substance). This drives the pH higher toward the normal range. Conversely, when the body’s pH is too high (alkaline), the kidneys increase the amount bicarbonate released in the urine, and retain acid to lower the pH back toward the normal range. The pH of urine shifts up or down as the kidneys
adjust to blood acidity or alkalinity. Although the body can generally maintain pH balance, some conditions can overwhelm the body’s ability to react to an imbalance. Acid-base imbalances can also occur when lung or kidney disorders affect the ability of these organs to control for pH imbalances. Metabolic vs Respiratory Acidosis and AlkalosisAcidosis and alkalosis are categorized according to whether they are caused by metabolic (related to basic bodily processes) versus respiratory (lung) problems. Understanding and determining the cause of the imbalance is important in helping to guide treatment of the pH imbalance. The categories of acidosis are:
The categories of alkalosis are:
The following table summarizes how the body works to adjust for acid-base imbalances:
Common causes of acidosisThe table below provides examples of common causes of acidosis:
Common causes of alkalosisThe table below provides examples of common causes of alkalosis:
Mixed acid-base imbalancesMore than one acid-base imbalance can occur at the same time. This is called a mixed acid-base disorder or a complex acid-base disturbance. Mixed disorders happen when a patient has a condition that causes one type of imbalance then a second type of imbalance occurs. For example, a patient with an alcohol abuse disorder may develop ketoacidosis due to alcohol misuse and metabolic alkalosis due to vomiting with loss of stomach acid. The ketoacidosis increases the acidity of body fluids at the same time the loss of stomach acid decreases acidity. Another example of a mixed acid-base disorder may occur due to aspirin poisoning. Aspirin triggers increased breathing, which can lead to respiratory alkalosis due to hyperventilating. At the same time, aspirin is an acid, and large doses often cause metabolic acidosis. Mixed acid-base disturbances may result in misleading test results that seem normal. Health care providers must carefully review laboratory test results to determine whether a single or mixed acid-base imbalance is present. Testing for Acidosis and AlkalosisWhen an acid-base imbalance is suspected, your health care provider will evaluate your vital signs, including blood pressure, breath rate, pulse, and temperature, and order tests to help diagnose or rule it out. If acidosis or alkalosis is detected, you may also have additional tests to determine its cause. Some people may have testing for acidosis or alkalosis to follow up on abnormal results on a common screening test, such as a complete metabolic panel (CMP). Main testsDiagnosis is typically based on the results of the following tests:
Understanding acidosis and alkalosis test resultsBlood gas results are interpreted in the context of your symptoms and history, as well as results from other tests performed at the same time. Examples of test results associated with the four main acidosis and alkalosis conditions are provided in this table.
Additional testingAdditional testing may be done to understand the cause of acidosis or alkalosis. This is important because treatment typically is directed at the underlying cause. Testing may include one or more of the following, depending on the suspected cause:
Non-lab testsPatients who are undergoing evaluation for acidosis and alkalosis may also have some of the following non-lab tests performed to determine what might be the underlying cause:
Treatment of Acidosis and AlkalosisTreatment of both acidosis and alkalosis is almost always directed at reversing the cause of the disorder. It is rare for alkaline or acid substances to be given to restore balance. Treatment of acidosisHow acidosis is treated will depend on what is causing it. For example, in metabolic acidosis caused by untreated diabetes, therapy may be directed at controlling blood sugar with insulin. If acidosis is caused by breathing problems, treatment aims at improving lung function. If breathing is severely impaired, mechanical ventilation may be needed. Treatment of alkalosisMetabolic alkalosis may be treated by giving fluids and electrolytes while treating the cause of fluid loss. Respiratory alkalosis is treated by ensuring the patient has sufficient oxygen and treating the underlying cause of hyperventilating, such as an infection, pain, or anxiety. Related Content
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Accessed November 23, 2021. https://emedicine.medscape.com/article/242975-overview See More See Less Ask a Laboratory Scientist
This form enables patients to ask specific questions about lab tests. Your questions will be answered by a laboratory scientist as part of a voluntary service provided by one of our partners, American Society for Clinical Laboratory Science. Please allow 2-3 business days for an email response from one of the volunteers on the Consumer Information Response Team. Send Us Your Question Send Us Your QuestionWhat are the three blood variables considered when making a diagnosis of acidosis or alkalosis?These variables are carbon dioxide, relative electrolyte concentrations, and total weak acid concentrations. All changes in blood pH, in health and in disease, occur through changes in these three variables.
What blood test shows acidosis?The anion gap blood test shows whether your electrolytes are out of balance or if your blood is too acidic or not acidic enough. Too much acid in the blood is called acidosis.
How is acidity in blood measured?There are two main types of tests that doctors can use to find out the pH of someone's blood: arterial blood gas testing and electrolyte testing. Knowing the pH of a person's blood can help a doctor find out if that person has an acid-base disorder.
What blood test is used to determine if a patient has an acidTo detect an acid-base disturbance, both a blood gas analysis and chemistry panel should be performed. This combines traditional blood gas analysis (Henderson-Hasselback equation) and the strong ion approach (by evaluating the contributions of electrolytes, in particular).
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