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Encyclopedia > Metabolic acidosis
Metabolic acidosis
Classification & external resources
Davenport diagram
ICD-10 E87.2
ICD-9 276.2
DiseasesDB 92
MedlinePlus 000335
eMedicine emerg/312  med/1458 ped/15

In medicine, metabolic acidosis is a state in which the blood pH is low (under 7.35) due to increased production of H+ by the body or the inability of the body to form bicarbonate (HCO3-) in the kidney. Its causes are diverse, and its consequences can be serious, including coma and death. Together with respiratory acidosis, it is one of the two general types of acidosis. Image File history File links No higher resolution available. ... In acid base physiology, the Davenport Diagram is a graphical tool, developed by Horace Davenport, that allows a clinician or investigator to describe blood bicarbonate concentrations and blood pH following a respiratory and/or metabolic acid-base disturbance. ... The International Statistical Classification of Diseases and Related Health Problems (commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following codes are used with International Statistical Classification of Diseases and Related Health Problems. ... // E00-E35 - Endocrine diseases (E00-E07) Disorders of thyroid gland (E00) Congenital iodine-deficiency syndrome (E01) Iodine-deficiency-related thyroid disorders and allied conditions (E02) Subclinical iodine-deficiency hypothyroidism (E03) Other hypothyroidism (E030) Congenital hypothyroidism with diffuse goitre (E031) Congenital hypothyroidism without goitre (E032) Hypothyroidism due to medicaments and other... The International Statistical Classification of Diseases and Related Health Problems (commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... MedlinePlus (medlineplus. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... medicines, see medication and pharmacology. ... The correct title of this article is . ... This article is about the chemistry of hydrogen. ... In inorganic chemistry, a bicarbonate (IUPAC-recommended nomenclature: hydrogencarbonate) is an intermediate form in the deprotonation of carbonic acid. ... It has been suggested that Renal anomalies and Renal plasma threshold be merged into this article or section. ... In medicine, a coma (from the Greek koma, meaning deep sleep) is a profound state of unconsciousness. ... This article or section does not cite its references or sources. ... Respiratory acidosis is acidosis (abnormal acidity of the blood) due to decreased ventilation of the pulmonary alveoli, leading to elevated arterial carbon dioxide concentration. ... Acidosis is an increased acidity (i. ...

Contents

Signs and symptoms

Symptoms are aspecific, and diagnosis can be difficult unless the patient presents with clear indications for arterial blood gas sampling. Symptoms may include chest pain, palpitations, headache, altered mental status, decreased visual acuity, nausea, vomiting, abdominal pain, altered appetite (either loss of or increased) and weight loss (longer term), muscle weakness and bone pains. Those in metabolic acidosis may exhibit deep, rapid breathing called Kussmaul respirations which is classically associated with diabetic ketoacidosis. Rapid deep breaths increase the amount of carbon dioxide exhaled, thus lowering the serum carbon dioxide levels, resulting in a compensatory respiratory alkalosis. Arterial blood gas measurement is a blood test that is performed to determine the concentration of oxygen, carbon dioxide and bicarbonate, as well as the pH, in the blood. ... In medicine, chest pain is a symptom of a number of serious conditions and is generally considered a medical emergency, unless the patient is a known angina pectoris sufferer and the symptoms are familiar (appearing at exertion and resolving at rest, known as stable angina). // Causes Cardiopulmonary Important cardiovascular and... A palpitation is an abnormal, rapid beating of the heart, brought on by overexertion, disease or drugs. ... A headache is a condition of pain in the head; sometimes neck or upper back pain may also be interpreted as a headache. ... For other uses, see Nausea (disambiguation). ... Vomiting (also throwing up or emesis) is the forceful expulsion of the contents of ones stomach through the mouth and sometimes the nose. ... Abdominal pain can be one of the symptoms associated with transient disorders or serious disease. ... Weight loss, in the context of medicine or health, is a reduction of the total body weight, which can mean loss of fluid, muscle or bone mass, or fat. ... Kussmaul breathing is the rapid, deep, and labored breathing of people who have acidosis. ... Ketoacidosis is a type of metabolic acidosis which is caused by high concentrations of keto acids, formed by the deamination of amino acids. ...


Extreme acidosis leads to neurological and cardiac complications:

Physical examination occasionally reveals signs of disease, but is otherwise normal. Cranial nerve abnormalities are reported in ethylene glycol poisoning, and retinal edema can be a sign of methanol (methyl alcohol) intoxication. Longstanding chronic metabolic acidosis leads to osteoporosis and can cause fractures. In medicine, a coma (from the Greek koma, meaning deep sleep) is a profound state of unconsciousness. ... This article is about the medical term, epileptic seizure, as distinct from psychogenic non-epileptic seizure. ... A cardiac arrhythmia, also called cardiac dysrhythmia, is a disturbance in the regular rhythm of the heartbeat. ... Tachycardia is an abnormally rapid beating of the heart, defined as a resting heart rate of over 100 beats per minute. ... Adrenaline redirects here. ... In physiology and medicine, hypotension refers to an abnormally low blood pressure. ... In medicine, the physical examination or clinical examination is the process by which the physician investigates the body of a patient for signs of disease. ... Cranial nerves are nerves which start directly from the brainstem instead of the spinal cord. ... Ethylene glycol (monoethylene glycol (MEG), IUPAC name: ethane-1,2-diol) is an alcohol with two -OH groups (a diol), a chemical compound widely used as an automotive antifreeze. ... Human eye cross-sectional view. ... Edema (American English) or oedema (British English), formerly known as dropsy or hydropsy, is swelling of any organ or tissue due to accumulation of excess lymph fluid, without an increase of the number of cells in the affected tissue. ... Methanol, also known as methyl alcohol, wood alcohol or wood spirits, is a chemical compound with chemical formula CH3OH. It is the simplest alcohol, and is a light, volatile, colourless, flammable, poisonous liquid with a distinctive odor that is somewhat milder and sweeter than ethanol (ethyl alcohol). ... Osteoporosis is a disease of bone in which the bone mineral density (BMD) is reduced, bone microarchitecture is disrupted, and the amount and variety of non-collagenous proteins in bone is altered. ... For fractures in geologic formations, see Rock fracture. ...


Diagnosis

Arterial blood gas sampling is essential for the diagnosis. The pH is low (under 7.35) and the bicarbonate levels are decreased (<12 mmol/l). In respiratory acidosis (low blood pH due to decreased clearance of carbon dioxide by the lungs), the bicarbonate is elevated, due to increased conversion from H2CO3. An ECG can be useful to anticipate cardiac complications. Arterial blood gas measurement is a blood test that is performed to determine the concentration of oxygen, carbon dioxide and bicarbonate, as well as the pH, in the blood. ... Respiratory acidosis is acidosis (abnormal acidity of the blood) due to decreased ventilation of the pulmonary alveoli, leading to elevated arterial carbon dioxide concentration. ... Carbon dioxide is a chemical compound composed of one carbon and two oxygen atoms. ... Respiratory system The lungs flank the heart and great vessels in the chest cavity. ... ECG may also refer to the East Coast Greenway Lead II An Electrocardiogram (ECG or EKG, abbreviated from the German Elektrokardiogramm) is a graphic produced by an electrocardiograph, which records the electrical voltage in the heart in the form of a continuous strip graph. ...


Other tests that are relevant in this context are electrolytes (including chloride), glucose, renal function and a full blood count. Urinalysis can reveal acidity (salicylate poisoning) or alkalinity (renal tubular acidosis type I). In addition, it can show ketones in ketoacidosis. An electrolyte is a substance containing free ions which behaves as an electrically conductive medium. ... The chloride ion is formed when the element chlorine picks up one electron to form an anion (negatively-charged ion) Cl−. The salts of hydrochloric acid HCl contain chloride ions and are also called chlorides. ... Glucose (Glc), a monosaccharide (or simple sugar), is the most important carbohydrate in biology. ... In medicine (nephrology) renal function is an indication of the state of the kidney and its role in physiology. ... A full blood count (FBC) or complete blood count (CBC) is a test requested by a doctor or other medical professional that gives information about the cells in a patients blood. ... Salicylic acid is a colorless, crystalline organic carboxylic acid. ...


To distinguish between the main types of metabolic acidosis, a clinical tool called the anion gap is considered very useful. It is calculated by subtracting the chloride and bicarbonate levels from the sodium plus potassium levels. The anion gap is used to aid in the differential diagnosis of metabolic acidosis. ...


Anion gap = ( [Na+]+[K+] ) - ( [Cl-]+[HCO3-] )


As sodium is the main extracellular cation, and chloride and bicarbonate are the main anions, the result should reflect the remaining anions. Normally, this concentration is about 8-16 mmol/l. An elevated anion gap (i.e. > 16 mmol/l) can indicate particular types of metabolic acidosis, particularly certain poisons, lactate acidosis and ketoacidosis.


As the differential diagnosis is narrowed down, certain other tests may be necessary, including toxicological screening and imaging of the kidneys. In medicine, differential diagnosis (sometimes abbreviated DDx or ΔΔ) is the systematic method physicians use to identify the disease causing a patients symptoms. ...


Causes

The causes are best grouped by their influence on the anion gap: The anion gap is used to aid in the differential diagnosis of metabolic acidosis. ...


Increased anion gap

Causes incluce:

The mnemomic MUDPILES is commonly used to remember the causes of Increased anion gap metabolic acidosis.[1][2] Lactic acidosis is a condition caused by the buildup of lactic acid in the body. ... Ketoacidosis is a type of metabolic acidosis which is caused by high concentrations of keto acids, formed by the deamination of amino acids. ... In inorganic chemistry, a sulfate (IUPAC-recommended spelling; also sulphate in British English) is a salt of sulfuric acid. ... Above is a ball-and-stick model of the inorganic hydrogenphosphate anion (HPO42−). Colour coding: P (orange); O (red); H (white). ... This article or section is in need of attention from an expert on the subject. ... An organic acid is an organic compound that is an acid. ... Salicylic acid is a colorless, crystalline organic carboxylic acid. ... Ethanol, also known as ethyl alcohol or grain alcohol, is a flammable, colorless, slightly toxic chemical compound with a distinctive perfume-like odor, and is the alcohol found in alcoholic beverages. ... Methanol, also known as methyl alcohol, wood alcohol or wood spirits, is a chemical compound with chemical formula CH3OH. It is the simplest alcohol, and is a light, volatile, colourless, flammable, poisonous liquid with a distinctive odor that is somewhat milder and sweeter than ethanol (ethyl alcohol). ... The chemical compound formaldehyde (also known as methanal) is a gas with a pungent smell. ... Ethylene glycol (monoethylene glycol (MEG), IUPAC name: ethane-1,2-diol) is an alcohol with two -OH groups (a diol), a chemical compound widely used as an automotive antifreeze. ... Paraldehyde is the cyclic form of three acetaldehyde molecules (a trimer). ... INH Stands for Inset Name Here, a spam forum on the Transformers discussion board www. ... Toluene, also known as methylbenzene or phenylmethane is a clear, water-insoluble liquid with the typical smell of paint thinners, redolent of the sweet smell of the related compound benzene. ... Sulfate is the IUPAC name for the SO42- ion, consisting of a central sulfur atom single bonded to four tetrahedrally oriented oxygen atoms. ... Metformin (INN, trade names Glucophage, Diabex, Diaformin, Fortamet, Riomet, Glumetza and others) is an anti-diabetic drug from the biguanide class (its other members are the withdrawn agents phenformin and buformin). ... Rhabdomyolysis is the breakdown of skeletal muscle due to injury, either mechanical, physical or chemical. ...

  • M-Methanol
  • U-Uremia
  • D-Diabetic Ketoacidosis
  • P-Paraldehyde
  • I-Infection, Iron, Isoniazid
  • L-Lactic acidosis
  • E-Ethylene Glycol, Ethanol
  • S-Salicylates

Normal anion gap

Causes include:[3]

It bears noting that the anion gap can be spuriously normal in sampling errors of the sodium level, e.g. in extreme hypertriglyceridemia. The anion gap can be increased due to relatively low levels of cations other than sodium and potassium (e.g. calcium or magnesium). Types 5-7 on the Bristol Stool Chart are often associated with diarrhea Diarrhea (in American English) or diarrhoea (in British English) is a generally unpleasant condition in which the sufferer has frequent watery, loose bowel movements (from the ancient Greek word διαρροή = leakage; literally meaning to run through). Acute infectious... A pancreatic fistula is an abnormal communication between the pancreas (actually pancreatic duct) and the exterior of the body via the abdominal wall. ... Hyperchloremic acidosis is a form of Metabolic acidosis associated with a normal anion gap, a decrease in bicarbonate, and in increase in chloride. ... Ammonium chloride or Sal Ammoniac (chemically ammonium chloride (NH4Cl); also nushadir salt, zalmiak, sal armagnac, sal armoniac, salmiakki, salmiak and salt armoniack) is, in its pure form, a clear white water-soluble crystalline salt with a biting taste. ... Acetazolamide, sold under the trade name Diamox®, is a carbonic anhydrase inhibitor that is used to treat glaucoma, epileptic seizures, benign intracranial hypertension and altitude sickness. ... In pharmacology, bile acid sequestrants a group of medication used for binding bile in the gastrointestinal tract. ... Renal failure is the condition in which the kidneys fail to function properly. ... In medicine, hypertriglyceridemia (or Hypertriglyceridaemia) denotes high (hyper-) blood levels (-emia) of triglycerides, the most abundant fatty molecule in most organisms. ...


Pathophysiology

Compensatory mechanisms

Metabolic acidosis is either due to increased generation of acid or an inability to generate sufficient bicarbonate. The body regulates the acidity of the blood by four buffering mechanisms.

The Bicarbonate buffering system is the most important buffer for mantaining a relatively constant pH in the plasma. ... In cell biology, molecular biology and related fields, the word intracellular means inside the cell. It is used in contrast to extracellular (outside the cell). ... Respiratory compensation is a mechanism by which plasma pH can be altered by varying the respiratory rate. ... Renal compensation is a mechanism by which the kidneys can regulate the plasma pH. It is slower than respiratory compensation, but has a greater ability to restore normal values. ...

Buffer

The decreased bicarbonate that distinguishes metabolic acidosis is therefore due to two separate processes: the buffer (from water and carbon dioxide) and additional renal generation. The buffer reactions are:

H+ + HCO3- <--> H2CO3 <--> CO2 + H2O

The Henderson-Hasselbalch equation mathematically describes the relationship between blood pH and the components of the bicarbonate buffering system: The Henderson-Hasselbalch (frequently misspelled Henderson-Hasselbach) equation in chemistry describes the derivation of pH as a measure of acidity (using pKa, the acid dissociation constant) in biological and chemical systems. ...

pH=pKa + log [HCO3-]/[CO2]
Using Henry's Law, we can say that [CO2]=0.03xPaCO2
(PaCO2 is the pressure of CO2 in arterial blood)
Adding the other normal values, we get
pH = 6.1 + log (24/0.03x40)
= 6.1 + 1.3
= 7.4

Treatment

A pH under 7.1 is an emergency, due to the risk of cardiac arrhythmias, and may warrant treatment with intravenous bicarbonate. Bicarbonate is given at 50-100 mmol at a time under scrupulous monitoring of the arterial blood gas readings. This intervention however, is not effective in case of lactic acidosis. Cardiac arrhythmia is a group of conditions in which the muscle contraction of the heart is irregular or is faster or slower than normal. ... Lactic acidosis is a condition caused by the buildup of lactic acid in the body. ...


If the acidosis is particularly severe and/or there may be intoxication, consultation with the nephrology team is considered useful, as dialysis may clear both the intoxication and the acidosis. Nephrology is the branch of internal medicine dealing with the study of the function and diseases of the kidney. ... In medicine, dialysis is a type of renal replacement therapy which is used to provide an artificial replacement for lost kidney function due to renal failure. ...


References

  1. ^ Mnemonic at medicalmnemonics.com 1203 3255
  2. ^ http://fitsweb.uchc.edu/student/selectives/TimurGraham/Anion_Gap.html
  3. ^ Mnemonic at medicalmnemonics.com 2001

  Results from FactBites:
 
Metabolic acidosis - Wikipedia, the free encyclopedia (964 words)
Metabolic acidosis is either due to increased generation of acid or an inability to generate sufficient bicarbonate.
The elevated bicarbonate that distinguishes metabolic acidosis is therefore due to two separate processes: the buffer (from water and carbon dioxide) and additional renal generation.
If the acidosis is particularly severe and/or there may be intoxication, consultation with the nephrology team is considered useful, as dialysis may clear both the intoxication and the acidosis.
MedlinePlus Medical Encyclopedia: Acidosis (497 words)
Acidosis is a condition characterized by excessive acid in the body fluids.
Acidosis is caused by an accumulation of acid or a significant loss of bicarbonate.
Lactic acidosis is an accumulation of lactic acid.
  More results at FactBites »


 

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