Acidosis: Difference between revisions

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==Overview==
==Overview==
:''For acidosis referring to acidity of the urine, see [[renal tubular acidosis]].''
:''For acidosis referring to acidity of the urine, see [[renal tubular acidosis]].''


Acidosis is an increased [[acidity]] (i.e. an increased [[hydrogen ion]] [[concentration]]).  If not further qualified, it refers to acidity of the [[blood plasma]].  
Acidosis is an [[acid-base imbalance]] that is an increased [[acidity]] (i.e. an increased [[hydrogen ion]] [[concentration]]).  If not further qualified, it refers to acidity of the [[blood plasma]].  


Generally, acidosis is said to occur when arterial [[pH]] falls below 7.35, while its counterpart ([[alkalosis]]) occurs at a pH over 7.45. [[Arterial blood gas]] analysis and other tests are required to separate the main causes.
Generally, acidosis is said to occur when arterial [[pH]] falls below 7.35, while its counterpart ([[alkalosis]]) occurs at a pH over 7.45. [[Arterial blood gas]] analysis and other tests are required to separate the main causes.
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
| '''Drug Side Effect'''
|bgcolor="Beige"|[[Zidovudine Oral ]] , [[Zalcitabine]] , Therapy with carbonic anhydrase inhibitor , [[Phenformin]] , [[Paracetamol]] , [[Glyburide and Metformin ]] , [[Ethylene glycol]] ,Ethanol ingestion , [[Didanosine ]] , [[Carbonic anhydrase inhibitors]] , [[Biguanide]] , [[Aspirin]] , [[Acetylsalicylic acid]] , [[Acetazolamide]], [[Pergolide]]
|bgcolor="Beige"|
[[Acetazolamide]],
[[acetylsalicylic acid]],
[[aspirin]],
[[biguanide]],
[[carbonic anhydrase inhibitors]],
[[didanosine]],
[[ethanol ingestion]],
[[glyburide]],
[[metformin]],
[[paracetamol]],
[[pergolide]],
[[phenformin]],
[[zalcitabine]],
[[zidovudine]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
| '''Endocrine'''
|bgcolor="Beige"|[[Thyrotoxicosis]] , Pseudohypoaldosteronism type 2  , Pseudohypoaldosteronism type 1, autosomal recessive , Pseudohypoaldosteronism type 1, autosomal dominant  , Posttreatment of ketoacidosis  , [[Pheochromocytoma ]] , [[Ketoacidosis]] , [[Hypoglycemia]] , [[Hyperosmolar non-ketotic diabetic coma ]] , [[Diabetic Ketoacidosis]] , [[Diabetes ]] , [[Adrenal cortex insufficiency ]]
|bgcolor="Beige"|
[[Adrenal cortex insufficiency]],
[[diabetes]],
[[diabetic ketoacidosis]],
[[GRACILE syndrome]],
[[hyperchloremic acidosis]],
[[hyperosmolar non-ketotic diabetic coma]],
[[hypoglycemia]],
[[ketoacidosis]],
[[permanent neonatal diabetes mellitus]]
[[pheochromocytoma]],
[[thyrotoxicosis]]
|-  
|-  
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Environmental'''
| '''Environmental'''
|bgcolor="Beige"|Hypothermic shivering, [[Drowning]]
|bgcolor="Beige"|
[[Drowning]],
hypothermic shivering
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
| '''Gastroenterologic'''
|bgcolor="Beige"|[[Volvulus]] , Small intestine fistula , [[Short bowel syndrome ]] , Severe liver disease , Severe hepatopathy , Severe diarrhoea , [[Pancreatic fistula]] , [[Nausea and Vomiting]] , Mesenteric insufficiency , [[Liver disease  ]] , [[Ischemic colitis]] , [[Ileus]] , [[Diarrhea]] , [[Biliary fistula]] , [[Acute liver failure]]
|bgcolor="Beige"|
[[Acute liver failure]],
[[biliary fistula]],
[[chronic mesenteric insufficiency]]
[[diarrhea]],
[[fistula]],
[[hepatic failure]],
[[hepatopathy]],
[[ileus]],
[[ischemic colitis]],
[[liver disease]],
[[microvillus inclusion disease]],
[[nausea and vomiting]],
[[necrotizing enterocolitis]],
[[pancreatic fistula]],
[[severe liver disease]],
[[short bowel syndrome]],
[[small intestine fistula]],
[[volvulus]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Genetic'''
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"|
[[3-alpha-hydroxyisobutyryl-CoA hydrolase deficiency]],
[[3-Hydroxyacyl-CoA dehydrogenase II Deficiency]],
[[3-methylglutaconic aciduria]],
[[biotinidase deficiency]],
[[coenzyme Q cytochrome c reductase deficiency]],
[[complex 1 mitochondrial respiratory chain deficiency]],
[[cystinosis]],
[[fanconi syndrome]],
[[fanconi-ichthyosis-dysmorphism]],
[[fructose-1,6-bisphosphatase deficiency]],
[[glycogen storage diseases]],
[[glutaric aciduria type 1]],
[[glutaric acidemia type 2]]
[[GRACILE syndrome]],
[[inborn urea cycle disorder]],
[[lipoamide dehydrogenase deficiency]],
[[long-chain 3-hydroxyacyl-coenzyme A dehydrogenase deficiency]],
[[medium-chain 3-hydroxyacyl-coenzyme A dehydrogenase deficiency]],
[[MELAS]],
[[metabolic disorders]],
[[mitochondrial DNA depletion syndrome]],
[[mitochondrial myopathy]],
[[mitochondrial neurogastrointestinal encephalopathy syndrome]],
[[multiple carboxylase deficiency]],
[[myopathy]],
[[NADH CoQ reductase deficiency]],
[[Ondine's curse]],
[[propionic acidemia]],
[[pyruvate carboxylase deficiency]],
[[pyruvate dehydrogenase phosphatase deficiency]],
[[SCHAD deficiency]],
[[sideroblastic anemia]],
[[succinic acidemia]],
[[type I glycogen storage disease]],
[[Von Gierke disease]],
[[Wilson's Disease]],
hydroxyacyl-coa dehydrogenase deficiency type 2,
hydroxysteroid dehydrogenase deficiency,
mitochondrial encephalomyopathy aminoacidopathy
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
| '''Hematologic'''
|bgcolor="Beige"|[[Splenic infarction]] , Severe [[anaemia]]
|bgcolor="Beige"|[[Splenic infarction]] , severe [[anemia]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
| '''Infectious Disease'''
|bgcolor="Beige"|[[Sepsis]] , [[Infection]] , Fever , [[Disseminated Intravascular Coagulation]] , [[Clostridium Difficile]] , [[Cerebral Malaria]]  
|bgcolor="Beige"|[[Sepsis]], [[infection]], fever, [[disseminated intravascular coagulation]], [[clostridium difficile]], [[cerebral malaria]]  
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
| '''Neurologic'''
| '''Neurologic'''
|bgcolor="Beige"|[[Grand mal seizure ]] , [[Epilepsy]] , [[Coma]] , [[CNS depression]] , [[Cerebral hypoxia]] , [[Cerebral edema]]  
|bgcolor="Beige"| [[Acute disseminated encephalomyelitis]], [[grand mal seizure]], [[epilepsy]], [[coma]], [[CNS depression]], [[cerebral hypoxia]], [[cerebral edema]]  
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
| '''Nutritional/Metabolic'''
|bgcolor="Beige"|[[Total parenteral nutrition]] , [[Starvation]]  
|bgcolor="Beige"| [[Glutaric aciduria type 1]], [[glutaric acidemia type 2]], [[total parenteral nutrition]], [[starvation]]  
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
| '''Oncologic'''
| '''Oncologic'''
|bgcolor="Beige"|[[Tumor]] , [[ Myeloma ]] , [[Lymphoma]] , [[Leukemia]]  
|bgcolor="Beige"| [[Tumor]], [[myeloma]], [[lymphoma]], [[leukemia]]  
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
| '''Overdose/Toxicity'''
|bgcolor="Beige"|[[Toluene ]] , Salicylates , [[Ethylene glycol]] , Ethanol ingestion , [[Alcohol]] , [[Isopropyl alcohol]] , [[Diethylene glycol   ]]
|bgcolor="Beige"| [[Toluene]], Salicylates, [[ethylene glycol]], ethanol ingestion, [[alcohol]], [[isopropyl alcohol]], [[diethylene glycol]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
| '''Pulmonary'''
|bgcolor="Beige"|[[Status asthmaticus]] , Severe [[asthma ]] , [[Pulmonary Embolism]] , [[Infant respiratory distress syndrome]] , [[Hypercapnia]] , Following chronic [[hyperventilation]] CO2 intoxication , [[Chronic obstructive lung disease]] , [[Apnea]] , [[Acute Respiratory Distress Syndrome]]  
|bgcolor="Beige"| [[Status asthmaticus]], severe [[asthma]], [[pulmonary embolism]], [[infant respiratory distress syndrome]], [[hypercapnia]], following chronic [[hyperventilation]] CO2 intoxication, [[chronic obstructive lung disease]], [[apnea]], [[acute respiratory distress syndrome]]  
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
| '''Renal/Electrolyte'''
|bgcolor="Beige"|[[Uremic]] , Type 4 RTA (hypoaldosteronism)]] , Type 2 (proximal) renal tubular acidosis (RTA) , Type 1 (distal) RTA  , [[Renal tubular acidosis]] , [[Renal failure]] , Renal circulatory insufficiency , [[Proximal renal tubular acidosis]] , Kidney disorders , [[Hypokalaemic distal renal tubular acidosis ]] , Hyperkalaemic [[distal renal tubular acidosis ]] , [[Hyperkalaemia ]] , [[Distal renal tubular acidosis]] , Decreased renal acid excretion , [[Chronic kidney disease ]] , Chronic interstitial nephritis , [[Acute renal failure]] , [[Acute glomerulonephritis]]  
|bgcolor="Beige"| [[Hypoaldosteronism]], [[hypokalemic distal renal tubular acidosis]], hyperkalemic [[distal renal tubular acidosis]], kidney disorders, [[proximal renal tubular acidosis]], [[renal tubular acidosis]], [[renal failure]], renal circulatory insufficiency, [[hyperkalemia]], [[distal renal tubular acidosis]], decreased renal acid excretion, [[chronic kidney disease]], chronic interstitial nephritis, [[acute renal failure]], [[acute glomerulonephritis]]  
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
| '''Trauma'''
| '''Trauma'''
|bgcolor="Beige"|Traumatic [[shock]]  
|bgcolor="Beige"| Traumatic [[shock]]  
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Urologic'''
| '''Urologic'''
|bgcolor="Beige"|[[Ureterosigmoidostomy]] , Ureteral diversion  
|bgcolor="Beige"| [[Ureterosigmoidostomy]], [[urinary diversion]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
| '''Miscellaneous'''
|bgcolor="Beige"|[[Mitochondrial myopathy]] , Mitochondrial encephalomyopathy , [[Maple syrup urine disease]] , [[Malignant hyperpyrexia ]] , Loss of bicarbonate or bicarbonate precursors    , [[Hypoxia]] , [[Hypovolemia]] , [[Hyperchloremic acidosis]] , Heavy physical work , [[Glutathione synthase deficiency ]] , [[Glutaric aciduria type 1 ]] , [[Glutaric acidemia type 2 ]] , Glomerular/tubular retention acidosis , [[Galactose-1-phosphate uridyltransferase deficiency ]] , [[Fistula]] , [[Fanconi syndrome]] , Enzymatic defects in glycogenolysis or gluconeogenesis (as with type 1 glycogen storage disease) , [[Enhanced metabolic rate ]] , Drug-induced mitochondrial dysfunction due to zidovudine or stavudine , Dieting , Decreased oxygen delivery , Decreased activity of pyruvate dehydrogenase or pyruvate carboxylase , Complications During and Following [[Cardiac Catheterization]], Acute Disseminated Encephalomyelitis , 4-hydroxyphenylpyruvate hydroxylase deficiency , 3-Methylcrotonyl-CoA carboxylase deficiency ,  Altered redox state favoring pyruvate conversion to lactate ,
|bgcolor="Beige"| [[Hypoxia]], [[hypovolemia]] , heavy physical work, [[fistula]], [[enhanced metabolic rate]], [[diet]]
|-
|-
|}
|}
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===Causes in Alphabetical Order <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>===
===Causes in Alphabetical Order <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>===


{{MultiCol}}
{{columns-list|
*Altered redox state favoring pyruvate conversion to lactate 
* [[3-alpha-hydroxyisobutyryl-CoA hydrolase deficiency]]
*[[ Ethylene glycol ]]  
* [[3-Hydroxyacyl-CoA dehydrogenase II Deficiency]]
*[[3-Methylcrotonyl-CoA carboxylase deficiency ]]  
* [[3-methylglutaconic aciduria]]
*[[4-hydroxyphenylpyruvate hydroxylase deficiency ]]
* [[Acetazolamide]]
*[[Acetazolamide]],
* [[Acetylsalicylic acid]]
*[[Acetylsalicylic acid]]  
* [[Acute disseminated encephalomyelitis]]
*[[Acute Disseminated Encephalomyelitis]]  
* [[acute glomerulonephritis]]
*[[Acute glomerulonephritis]]  
* [[Acute liver failure]]
*[[Acute liver failure]]
* [[Acute renal failure]]
*Acute pulmonary edema 
* [[Acute respiratory distress syndrome]]
*[[Acute renal failure]]  
* [[Adrenal cortex insufficiency]]
*[[Acute Respiratory Distress Syndrome]]
* [[Alcohol]]
*[[Adrenal cortex insufficiency ]]
* [[Apnea]]
*[[Alcohol]]  
* [[Aspirin]]
*[[Apnea]]
* [[Beriberi heart disease]]
*[[Aspirin]]
* [[Biguanide]]
*[[Beriberi Heart Disease]]  
* [[Biliary fistula]]
*[[Biguanide]]
* [[Biotinidase deficiency]]
*[[Biliary fistula]]
* [[Carbon monoxide poisoning]]
*[[Carbon monoxide poisoning]]
* [[Carbonic anhydrase inhibitors]]
*[[Carbonic anhydrase inhibitors]]  
* [[Cardiac arrest]]
*[[Cardiac arrest]]  
* [[Cardiogenic shock]]
*[[Cardiogenic shock]]
* [[Cardiomyopathy]]
*[[Cerebral edema]]  
* [[Cataract and cardiomyopathy]]
*[[Cerebral hypoxia]]
* [[Cerebral edema]]
*[[Cerebral Malaria]]  
* [[Cerebral hypoxia]]
*Chronic interstitial nephritis
* [[Cerebral malaria]]
*[[Chronic kidney disease ]]  
* [[Chronic interstitial nephritis]]
*[[Chronic obstructive lung disease]]
* [[Chronic kidney disease]]
*[[Clostridium Difficile]]
* [[Chronic mesenteric insufficiency]]
*[[CNS depression]]  
* [[Chronic obstructive lung disease]]
*CO2 intoxication
* [[Clostridium difficile]]
*[[Cocaine ]]  
* [[CNS depression]]
*[[Coma]]
* [[Cocaine]]
*[[Complications During and Following Cardiac Catheterization]]
* [[Coenzyme Q cytochrome c reductase deficiency]]
*[[Congestive heart failure]]  
* [[Coma]]
*Cyanide intoxication 
* [[Complex 1 mitochondrial respiratory chain deficiency]]
*Decreased activity of pyruvate dehydrogenase or pyruvate carboxylase
* [[Congestive heart failure]]
*Decreased oxygen delivery
* [[Copperhead snake poisoning]]
*Decreased renal acid excretion  
* [[Crotalidae snake poisoning]]
*[[Diabetes ]]  
* [[Cyanide poisoning]]
*[[Diabetic Ketoacidosis]]
* [[Cystinosis]]
*[[Diarrhea]]  
* [[Decreased renal acid excretion]]
*[[Didanosine (patient information)]]
* [[Diabetes]]
*[[Diethylene glycol   ]]
* [[Diabetic ketoacidosis]]
*[[Dieting]]
* [[Diarrhea]]
*[[Disseminated Intravascular Coagulation]]  
* [[Didanosine]]
*[[Distal renal tubular acidosis]]
* [[Diethylene glycol]]
*[[Drowning]]
* [[Disseminated intravascular coagulation]]
*Drug-induced mitochondrial dysfunction due to zidovudine or stavudine
* [[Distal renal tubular acidosis]]
*Enhanced metabolic rate
* [[Drowning]]  
*Enzymatic defects in glycogenolysis or gluconeogenesis (as with type 1 glycogen storage disease) 
* [[Endothall]]
*[[Epilepsy]]
* [[Epilepsy]]
*Ethanol ingestion
* [[Ethanol]]
{{ColBreak}}
* [[Ethylene glycol]]
*[[Ethylene glycol]]  
* [[Fanconi syndrome]]
*[[Fanconi syndrome]]  
* [[Fanconi-ichthyosis-dysmorphism]]
*Fever  
* [[Fever]]
*[[Fistula]]
* [[Fistula]]
*Following chronic hyperventilation
* [[Fructose-16-bisphosphatase deficiency]]
*[[Galactose-1-phosphate uridyltransferase deficiency ]]  
* [[Germanium]]
*Glomerular/tubular retention acidosis
* [[Glutaric acidemia type 2]]
*[[Glutaric acidemia type 2 ]]  
* [[Glutaric aciduria type 1]]
*[[Glutaric aciduria type 1 ]]  
* [[Glyburide]]
*Glutathione synthase deficiency
* [[Glycogen storage diseases]]
*[[Glyburide]] and [[Metformin ]]
* [[GRACILE syndrome]]
*[[Grand mal seizure ]]
* [[Grand mal seizure]]
*Heavy physical work
* [[Hemorrhagic shock]]
*[[Hemorrhagic shock]]  
* [[Hepatic failure]]
*Hepatic or renal failure
* [[Hepatopathy]]
*[[Hypercapnia]]  
* [[Hydroxyacyl-coa dehydrogenase deficiency type 2]]
*[[Hyperchloremic acidosis]]  
* [[Hydroxysteroid dehydrogenase deficiency]]
*[[Hyperkalaemia ]]  
* [[Hypercapnia]]
*Hyperkalaemic distal renal tubular acidosis 
* [[Hyperchloremic acidosis]]
*[[Hyperosmolar non-ketotic diabetic coma ]]  
* [[Hyperkalemia]]
*[[Hypoglycemia]]
* [[Hyperosmolar non-ketotic diabetic coma]]
*[[Hypokalaemic distal renal tubular acidosis ]]
* [[Hypoaldosteronism]]
*[[Hypoperfusion ]]  
* [[Hypoglycemia]]
*Hypotension
* [[Hypokalemic distal renal tubular acidosis]]
*Hypotensive state
* [[Hypoperfusion]]
*Hypothermic shivering
* [[Hypothermic]] shivering
*[[Hypovolemia]]  
* [[Ileus]]
*[[Hypoxia]]  
* [[Inborn urea cycle disorder]]
*[[Ileus]]
* [[Infant respiratory distress syndrome]]
*[[Infant respiratory distress syndrome]]  
* [[Infection]]
*[[Infection]]  
* [[Ischemic colitis]]  
*[[Ischemic colitis]]  
* [[Isopropyl alcohol]]
*[[Isopropyl alcohol]]  
* [[Ketoacidosis]]
*[[Ketoacidosis]]
* [[Kidney disorders]]
*Kidney disorders
* [[Leukemia]]
*[[Leukemia]]
* [[Lipoamide dehydrogenase deficiency]]
*[[Liver disease ]]  
* [[Liver disease]]
*Loss of bicarbonate or bicarbonate precursors   
* [[Long-chain 3-hydroxyacyl-coenzyme A dehydrogenase deficiency]]
*[[Lymphoma]]  
* [[Lymphoma]]
*[[Malignant hyperpyrexia ]]  
* [[Malignant hypertension]]
*[[Malignant hypertension]]  
* [[Medium-chain 3-hydroxyacyl-coenzyme A dehydrogenase deficiency]]
*Malignant neoplastic conditions [[Myeloma]]
* [[MELAS]]
*[[Maple syrup urine disease]]  
* [[Metabolic disorders]]
*Mesenteric insufficiency
* [[Metformin]]
*[[Methanol]]  
* [[Methanol]]
*Mitochondrial encephalomyopathy
* [[Microvillus inclusion disease]]
*[[Mitochondrial myopathy]]
* [[Mitochondrial DNA depletion syndrome]]
*[[Mitochondrial toxicity]]  
* [[Mitochondrial encephalomyopathy aminoacidopathy]]
*[[Multiple organ dysfunction syndrome]]
* [[Mitochondrial myopathy]]
*[[Myocardial Infarction]]
* [[Mitochondrial neurogastrointestinal encephalopathy syndrome]]
*[[Nausea and Vomiting]]
* [[Multiple carboxylase deficiency]]
*[[Near-drowning ]]  
* [[Myeloma]]
*[[Neuroleptic malignant syndrome]]  
* [[Myocardial Infarction]]
*[[Pancreatic fistula]]
* [[Myopathy]]
*[[Paracetamol]]
* [[NADH CoQ reductase deficiency]]
*[[Pergolide]]
* [[Necrotizing enterocolitis]]
*[[Permissive hypercapnia]]
* [[Ondine's curse]]
{{ColBreak}}
* [[Pancreatic fistula]]
*[[Phenformin]]
* [[Paracetamol]]
*[[Pheochromocytoma ]]  
* [[Pergolide]]
*[[Pickwickian syndrome]]
* [[Permanent neonatal diabetes mellitus]]
*Posttreatment of [[ketoacidosis ]]  
* [[Phenformin]]
*[[Propylene glycol     ]]  
* [[Pheochromocytoma]]
*[[Proximal renal tubular acidosis]]
* [[Propionic acidemia]]
*Pseudohypoaldosteronism type 1, autosomal dominant 
* [[Propylene glycol]]
*Pseudohypoaldosteronism type 1, autosomal recessive
* [[Proximal renal tubular acidosis]]
*Pseudohypoaldosteronism type 2
* [[Pulmonary edema]]
*[[Pulmonary Embolism]]  
* [[Pulmonary embolism]]
*[[Pulseless electrical activity]]  
* [[Pulseless electrical activity]]
*Reduced oxygen utilization 
* [[Pyruvate carboxylase deficiency]]
*Renal circulatory insufficiency  
* [[Pyruvate dehydrogenase phosphatase deficiency]]
*[[Renal failure]]
* [[Renal circulatory insufficiency]]
*[[Renal tubular acidosis]]  
* [[Renal failure]]
*[[Salicylate]]  
* [[Renal tubular acidosis]]
*[[Sepsis]]  
* [[Salicylate]]
*Severe [[anaemia]]
* [[Salicylates]]
*Severe [[asthma ]]  
* [[SCHAD deficiency]]
*Severe [[burns]]
* [[Sepsis]]
*Severe [[diarrhoea]]
* [[Severe liver disease]]
*Severe exercise
* [[Shock]]
*Severe hepatopathy
* [[Short bowel syndrome]]
*Severe hypoxemia
* [[Sideroblastic anemia]]
*Severe liver disease
* [[Small intestine fistula]]
*[[Shock]]  
* [[ST elevation myocardial infarction]]
*[[Short bowel syndrome ]]
* [[Starvation]]
*Small intestine [[fistula
* [[Status asthmaticus]]
*[[Splenic infarction]]
* [[Strychnine]]
*[[ST Elevation Myocardial Infarction Complications]]
* [[Succinic acidemia]]
*[[Starvation]]
* [[Thyrotoxicosis]]
*[[Status asthmaticus]]
* [[Toluene]]
*Therapy with carbonic anhydrase inhibitor
* [[Torsade de pointes]]
*[[Thyrotoxicosis]]
* [[Total parenteral nutrition]]
*[[Tissue hypoxia]]  
* [[Tumor]]
*[[Toluene ]]  
* [[Type I glycogen storage disease]]
*[[Torsade de pointes]]
* [[Ureterosigmoidostomy]]
*[[Total parenteral nutrition]]
* [[Urinary diversion]]
*Traumatic [[shock]]
* [[Ventricular arrhythmias]]
*[[Tumor]]
* [[Ventricular fibrillation]]
*Type 1 (distal) RTA
* [[Volvulus]]
*Type 2 (proximal) renal tubular acidosis (RTA)
* [[Vomiting]]
*Type 4 RTA (hypoaldosteronism)
* [[Von Gierke disease]]
*[[Uremic]]
* [[Wilson's Disease]]
*Ureteral diversion
* [[Zalcitabine]]
*[[Ureterosigmoidostomy]]  
*[[Zidovudine]]
*[[Ventricular arrhythmias]]  
}}
*[[Ventricular fibrillation]]  
*[[Volvulus]]
*[[Vomiting]]  
*[[Zalcitabine]]  
*[[Zidovudine Oral ]]  
{{EndMultiCol}}




Latest revision as of 20:03, 10 January 2020
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List of terms related to Acidosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Carlos A Lopez, M.D. [2]

Overview

For acidosis referring to acidity of the urine, see renal tubular acidosis.

Acidosis is an acid-base imbalance that is an increased acidity (i.e. an increased hydrogen ion concentration). If not further qualified, it refers to acidity of the blood plasma.

Generally, acidosis is said to occur when arterial pH falls below 7.35, while its counterpart (alkalosis) occurs at a pH over 7.45. Arterial blood gas analysis and other tests are required to separate the main causes.

Strictly speaking, the term acidemia would be more appropriate to describe the state of low blood pH, reserving acidosis to describe the processes leading to these states. Nevertheless, most physicians use the terms interchangeably. The distinction may be relevant where a patient has factors causing both acidosis and alkalosis, where the relative severity of both determines whether the result is a high or a low pH.

The rate of cellular metabolic activity affects and, at the same time, is affected by the pH of the body fluids. In mammals, the normal pH of arterial blood lies between 7.35 and 7.50 depending on the species (e.g. healthy human-arterial blood pH varies between 7.35 and 7.45). Blood pH values compatible with life in mammals are limited to a pH range between 6.8 and 7.8. Changes in the pH of arterial blood (and therefore the extracellular fluid) outside this range result in irreversible cell damage (Needham, 2004).

Classification

  • Acidosis can either be metabolic or respiratory.
    • Both are caused by low arterial pH.
    • Metabolic acidosis is due to an increased accumulation of acid equivalents through impairment of the regulatory ability of the liver, kidneys, or metabolism.
    • Respiratory acidosis is caused by a retention of carbon dioxide due to inadequate hypoventilation or pulmonary ventilation.

Pathophysiology

Respiratory acidosis

Respiratory acidosis results from a build-up of carbon dioxide in the blood (hypercapnia) due to hypoventilation. It is most often caused by pulmonary problems, although head injuries, drugs (especially anaesthetics and sedatives), and brain tumors can also bring it on. Emphysema, chronic bronchitis, asthma, severe pneumonia, and aspiration are among the most frequent causes. It can also occur as a response to chronic metabolic alkalosis.

Blood gases show pH below 7.35 as above mentioned, and PaCO2 will be high (>45 mmHg / 6 kPa).

The key to distinguish between respiratory and metabolic acidosis is that in respiratory acidosis, the CO2 is increased while the bicarbonate is either normal (uncompensated) or increased (compensated). Compensation occurs if respiratory acidosis persists for days or longer and a chronic phase is entered with partial buffering of the acidosis through renal bicarbonate retention.

Metabolic acidosis

Metabolic acidosis may result from disturbances in the ability to excrete acid via the kidneys. Renal acidosis is associated with an accumulation of urea and creatinine as well as metabolic acid residues of protein catabolism.

An increase in the production of metabolic acids may also produce metabolic acidosis. For example, lactic acidosis may occur from 1) severe (PaO2 <36mm Hg) hypoxemia causing a fall in the rate of oxygen diffusion from arterial blood to tissues, or 2) hypoperfusion (e.g. hypovolemic shock) causing an inadequate blood delivery of oxygen to tissues. A rise in lactate out of proportion to the level of pyruvate, e.g. in mixed venous blood, is termed "excess lactate" and is the best indicator of an inadequate flow of oxygen into the body's mitochondria from either cause. Oxygen debt (and muscle excess lactate) is also seen in strenuous exercise. Once oxygenation is restored, the acidosis clears quickly. Another example of increased production of acids occurs in starvation and diabetic acidosis. It is due to the accumulation of ketoacids (ketosis) and reflects a severe shift from glycolysis to lipolysis for fuel needs.

Acidic poisons, iron etc., and decreased production of bicarbonate may also produce metabolic acidosis.

Metabolic acidosis can result in stimulation of chemoreceptors and so increase alveolar ventilation, leading to respiratory compensation, otherwise known as Kussmaul breathing, which is a specific type of hyperventilation. Should this situation persist the patient is at risk for exhaustion leading to respiratory failure.

Mutations to the V-ATPase 'a4' or 'B1' isoforms result in distal renal tubular acidosis—a condition that leads to metabolic acidosis—in some cases with sensorineural deafness.

In blood gas tests, it is characterised by a low pH, low blood HCO3, and normal or low PaCO2. In addition to arterial blood gas one can use the anion gap to differentiate between possible causes.

The Henderson-Hasselbalch equation is useful for calculating blood pH, because blood is a buffer solution. The amount of metabolic acid accumulating can also be quantitated by using buffer base deviation, a derivative estimate of the metabolic as opposed to the respiratory component. In hypovolemic shock for example, approximately 50% of the metabolic acid accumulation is lactic acid, which disappears as blood flow and oxygen debt are corrected.

Causes

Common causes of acidosis


Causes by Organ System

Cardiovascular

Beriberi heart disease, cardiac arrest, cardiogenic shock, cardiogenic shock, cardiomyopathy, cataract and cardiomyopathy, congestive heart failure, hemorrhagic shock, hypoperfusion, hypotension, malignant hypertension, myocardial Infarction, pulseless electrical activity, pulmonary edema, shock, ST elevation myocardial infarction, torsade de pointes, ventricular arrhythmias, ventricular fibrillation

Chemical/Poisoning Alcohol, carbon monoxide poisoning, cocaine, copperhead snake poisoning, crotalidae snake poisoning, cyanide poisoning, diethylene glycol, endothall, ethanol, ethylene glycol, germanium, isopropyl alcohol, methanol, propylene glycol, salicylate, strychnine
Dental No underlying causes
Dermatologic No underlying causes
Drug Side Effect

Acetazolamide, acetylsalicylic acid, aspirin, biguanide, carbonic anhydrase inhibitors, didanosine, ethanol ingestion, glyburide, metformin, paracetamol, pergolide, phenformin, zalcitabine, zidovudine

Ear Nose Throat No underlying causes
Endocrine

Adrenal cortex insufficiency, diabetes, diabetic ketoacidosis, GRACILE syndrome, hyperchloremic acidosis, hyperosmolar non-ketotic diabetic coma, hypoglycemia, ketoacidosis, permanent neonatal diabetes mellitus pheochromocytoma, thyrotoxicosis

Environmental

Drowning, hypothermic shivering

Gastroenterologic

Acute liver failure, biliary fistula, chronic mesenteric insufficiency diarrhea, fistula, hepatic failure, hepatopathy, ileus, ischemic colitis, liver disease, microvillus inclusion disease, nausea and vomiting, necrotizing enterocolitis, pancreatic fistula, severe liver disease, short bowel syndrome, small intestine fistula, volvulus

Genetic

3-alpha-hydroxyisobutyryl-CoA hydrolase deficiency, 3-Hydroxyacyl-CoA dehydrogenase II Deficiency, 3-methylglutaconic aciduria, biotinidase deficiency, coenzyme Q cytochrome c reductase deficiency, complex 1 mitochondrial respiratory chain deficiency, cystinosis, fanconi syndrome, fanconi-ichthyosis-dysmorphism, fructose-1,6-bisphosphatase deficiency, glycogen storage diseases, glutaric aciduria type 1, glutaric acidemia type 2 GRACILE syndrome, inborn urea cycle disorder, lipoamide dehydrogenase deficiency, long-chain 3-hydroxyacyl-coenzyme A dehydrogenase deficiency, medium-chain 3-hydroxyacyl-coenzyme A dehydrogenase deficiency, MELAS, metabolic disorders, mitochondrial DNA depletion syndrome, mitochondrial myopathy, mitochondrial neurogastrointestinal encephalopathy syndrome, multiple carboxylase deficiency, myopathy, NADH CoQ reductase deficiency, Ondine's curse, propionic acidemia, pyruvate carboxylase deficiency, pyruvate dehydrogenase phosphatase deficiency, SCHAD deficiency, sideroblastic anemia, succinic acidemia, type I glycogen storage disease, Von Gierke disease, Wilson's Disease, hydroxyacyl-coa dehydrogenase deficiency type 2, hydroxysteroid dehydrogenase deficiency, mitochondrial encephalomyopathy aminoacidopathy

Hematologic Splenic infarction , severe anemia
Iatrogenic No underlying causes
Infectious Disease Sepsis, infection, fever, disseminated intravascular coagulation, clostridium difficile, cerebral malaria
Musculoskeletal/Orthopedic No underlying causes
Neurologic Acute disseminated encephalomyelitis, grand mal seizure, epilepsy, coma, CNS depression, cerebral hypoxia, cerebral edema
Nutritional/Metabolic Glutaric aciduria type 1, glutaric acidemia type 2, total parenteral nutrition, starvation
Obstetric/Gynecologic No underlying causes
Oncologic Tumor, myeloma, lymphoma, leukemia
Ophthalmologic No underlying causes
Overdose/Toxicity Toluene, Salicylates, ethylene glycol, ethanol ingestion, alcohol, isopropyl alcohol, diethylene glycol
Psychiatric No underlying causes
Pulmonary Status asthmaticus, severe asthma, pulmonary embolism, infant respiratory distress syndrome, hypercapnia, following chronic hyperventilation CO2 intoxication, chronic obstructive lung disease, apnea, acute respiratory distress syndrome
Renal/Electrolyte Hypoaldosteronism, hypokalemic distal renal tubular acidosis, hyperkalemic distal renal tubular acidosis, kidney disorders, proximal renal tubular acidosis, renal tubular acidosis, renal failure, renal circulatory insufficiency, hyperkalemia, distal renal tubular acidosis, decreased renal acid excretion, chronic kidney disease, chronic interstitial nephritis, acute renal failure, acute glomerulonephritis
Rheumatology/Immunology/Allergy No underlying causes
Sexual No underlying causes
Trauma Traumatic shock
Urologic Ureterosigmoidostomy, urinary diversion
Miscellaneous Hypoxia, hypovolemia , heavy physical work, fistula, enhanced metabolic rate, diet

Causes in Alphabetical Order [1] [2]


Respiratory Acidosis


Treatment

Treatment of any of the varieties of metabolic acidosis is focused upon correction of the underlying problem. However, neutralizing the acidosis with infusions of bases like sodium bicarbonate may be temporarily helpful in some critical emergencies.

References

  1. ↑ Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
  2. ↑ Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X

External Links

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