Depending on the presence or absence of unmearable anions in the plasma, metabolic acidosis differ with a large and normal anionic slit. The causes of metabolic acidosis include the accumulation of ketone bodies, renal failure or consumption of drugs or toxins (large anionic slit), as well as losses of HCO 3 - through the gastrointestinal tract or kidney (normal anionic gap).
This state occurs either with excessive production by the organism of acids, or with their lack of elimination by the kidneys.
Causes of metabolic acidosis
Great anionic gap:
Normal anionic slit (hyperchloremic acidosis):
Metabolic acidosis is the accumulation of acids due to increased education or consumption, reduced removal from the body or loss of HCO 3 - through the gastrointestinal tract or kidneys. When the acid load exceeds the capabilities of respiratory compensation, an acdeemia is developing. The causes of metabolic acidosis are classified by their influence on the anionic gap.
Acidosis with a large anionic gap. The most frequent causes of acidosis with a large anionic slit are:
- ketoacidosis;
- lactacidosis;
- renal failure;
- toxins poisoning.
Ketoacidosis is a frequent complication of type 1 diabetes mellitus, but it also develops with chronic alcoholism, insufficient nutrition and (less often) starvation. Under these conditions, the body instead of glucose uses free fatty acids (szhk). In the liver, the SBC is converted into ketocislotes - acetoxus and β-hydroxymalass (immeasurable anions). Ketoacidosis is sometimes observed with congenital isovabler and Matilmalon acdemia.
Lacatatacidosis is the most common cause of metabolic acidosis in hospitalized patients. Lactat accumulates as a result of its increased education in combination with reduced recycling. Excess lactate products occurs during anaerobic metabolism. The most severe forms of lactatacidosis are observed at various types of shock. Reduced lactate utilization is characteristic of disorders of the liver function due to the local decrease in its perfusion or due to generalized shock.
Renal failure contributes to the development of acidosis with a large anionic slit due to reducing the excretion of acid and disorders of HCO 3 reabsorption. The large anionic slit is explained by the accumulation of sulfates, phosphates, urates and hippaths.
Toxins can be metabolized to form acidic products or induced lactatacidosis. A rare cause of metabolic acidosis is rhabdomyolysis; It is believed that the muscles are directly released by protons and anions.
Acidosis with normal anionic slit. The most common causes of acidosis with normal anionic slit are:
- loss of NSO3- through the gastrointestinal tract or kidney;
- disruption of renal excretion of acids.
Metabolic acidosis with a normal anionic slit is also called hyperchloremic acidosis, because in the kidneys instead of HCO 3 - CL is reabsorbed.
In many secrets of the gastrointestinal tract (for example, in bile, pancreatic juice and intestinal fluid) there are a large amount of HCO 3 -. The loss of this ion with diarrhea, drainage of the stomach or the presence of fistulas can cause acidosis. With ureterosigmoidostomy (implantation of ureters in a sigmoid intestine in their obstruction or removal of the bladder) the intestine secretes and loses T 3 - in exchange for the CL present in the urine - and sucks ammonium from urine, which dissociates ammonia. In rare cases, the loss of HCO 3 - causes the intake of ion exchange resins that bind this anion.
With different types of renal tubular acidosis, either the secretion of H + 3 - (types 1 and 4) is broken, or the absorption of HCO 3 - (type 2). Violation of the excretion of acids and the normal anionic slit is also recorded in the early stages of renal failure, tubuline-intersticial nephritis and reception of carbonic henching inhibitors (for example, acetazolamide).
Symptoms and signs of metabolic acidosis
Symptoms and signs are mainly caused by metabolic acidosis. Easy acidemiya itself proceeds asymptomatic. With a more pronounced arrival, nausea, vomiting and overall malaise are capable of occurring.
The heavy acute acdeemia is a factor predisposing a heart function with a drop of blood pressure and the development of shock, ventricular arrhythmias and coma.
Symptoms are usually nonspecific, and therefore, the differential diagnosis of this state in patients who performed intestinal plastic urinary tract was performed. Symptoms are developing for a long time and may include anorexia, body weight loss, polydipsy, lethargy, fast fatigue. Also, the pain per chest, reinforced and rapid heartbeat, headache, changes in mental state, such as a pronounced anxiety (due to hypoxia), changes in appetite, muscle weakness and bone pain is also.
Diagnosis of metabolic acidosis
- Definition of gas and serum electrolytes.
- Calculation of anionic gap and its delta.
- The use of the Winter formula to calculate compensatory changes.
- Clarification of the cause.
Clarification of the causes of metabolic acidosis begin with the calculation of the anionic gap.
The cause of large anionic cracks is obvious; Otherwise, blood test is needed to determine glucose, urea nitrogen, creatinine, lactate and probable toxins. Most laboratories determine the level of salicylates, but not methanol or ethylene glycol. The presence of the latter indicates the osmolar slot. Calculated serum osmolarness is deducted from measured osmolarity. Although the osmolar slot and light accidosis may be due to the taking ethanol, the latter never causes pronounced metabolic acidosis.
If an anionic slot is normal, and the obvious cause of acidosis (for example, diarrhea) is absent, then the electrolytes in the urine are determined and the anionic urine slot is calculated: + [k] -. Normally (including patients with losses through the gastrointestinal tract) anionic urine slot is 30-50 MEKV / l. Its increase indicates the renal loss of HCO 3 -. In addition, with metabolic acidosis, the delta of anionic slit is calculated to detect the concomitant metabolic alkalosis and according to the Water formula, whether respiratory compensation is adequate or reflects the second disorder of the acid-base balance.
When using a fine or colon segment, hyperchloremic metabolic acidosis can develop. When using a part of the stomach, hypochloremic metabolic acidosis can develop.
The diagnosis is made on the basis of indicators of the gas composition of arterial blood, while the pH will be low (<7,35). Избыток оснований может быть меньше чем 3 ммоль/л. Кроме этого, важными являются данные анализа венозной крови, показывающие уровень электролитов, бикарбоната (низкий, <20 ммоль/л), хлоридов, показателей функций почек, концентрации глюкозы в крови, а также результаты общего анализа крови. Анализ мочи необходим для определения ее кислотности/защелачивания, а также наличия кетоновых тел. Следует рассчитать анионную разницу по формуле: (Na + + К +) - (С1 + + HCO 3 -), которая должна быть в норме (<20) при адекватном отведении мочи.
Treatment of metabolic acidosis
- Remedy.
- In rare cases, the introduction of NaHCO 3 is shown.
The use of NaHCO 3 - in the therapy of the anciend is shown only in some circumstances, and in others it can be dangerous. When metabolic acidosis is due to the loss of HCO 3 or accumulation of inorganic acids, the introduction of HCO 3 is, as a rule, is safe and adequate. However, when the acidosis is due to the accumulation of organic acids, then there are no distinct data, which would indicate a decrease in mortality with the introduction of HCO 3 - conjugate with many risks. In the treatment of the underlying disease, lactate and ketocislotes turn back to HCO 3 -. Therefore, the introduction of exogenous HCO 3 can determine the "overheet", i.e. Development of metabolic alkalosis. With many states, the introduction of HCO 3 can also cause an overload of Na and the volume, hypokalemia and (due to the oppression of the activity of the respiratory center) hypercup. In addition, since HCO 3 does not diffuse through cell membranes, its introduction does not lead to the correction of intracellular acidosis and, moreover, it can paradoxically worsen the state, since part of the HCO 3 input - turns into carbon dioxide that penetrates cells and is hydrolyzed with Education H + and HCO 3 -.
Despite these and other risks, the greed of specialists is still recommended in / in the introduction of HCO 3 - with severe metabolic acidosis in order to achieve pH 7,20.
Such treatment requires two preliminary calculations. The first is to determine the amount to which the HCO 3 level should be increased; The calculation is made according to the Cassirera-Blake equation, taking the value of H + at pH 7.2 equal to 63 nmol / l: 63 \u003d 24хpco 2 / HCO 3 - or the desired level of HCO 3 - \u003d 0.38HPCO 2 NAHCO 3 - which you want to enter To achieve this level is calculated as follows:
NaHCO 3 - (IEC) \u003d (needed -Mimed) x0.4hves of the body (kg).
This amount of NaHCO 3 is introduced in a few hours. Every 30 min - 1 hour pH should determine the pH and the level of NaHCO 3 - in serum, giving time to equilibration with the output HCO 3 -.
Instead of NaHCO 3 - you can apply:
- thromethamine - AminosPirt, which neutralizes the acids formed both in metabolic (H +) and with respiratory acidosis;
- carbicarb - an equimolar mixture of NaHCO 3 - and carbonate (the latter binds CO 2 to the formation of HCO 3 -);
- dicharocetate, which enhances lactate oxidation.
The advantages of all these compounds are not proven, and they are inherent in their own negative effects.
It is often necessary to determine the level K + in serum in order to diagnose its reduction in a timely manner, which usually occurs during metabolic acidosis, and, if necessary, enter KCl inside or parenterally.
Provided that the patient can be treated in outpatient conditions, the absidosis is corrected by the tablet form of sodium bicarbonate.
With the value of pH, less than 7.1 shows an intravenous infusion of a hypertensive solution of sodium bicarbonate [two ampoules of 50 ml of 8.4% NaHCO 3 (50 MKV)] with strict control of the gas composition of arterial blood. This therapy should be carried out under the control of the nephrologist and resuscitation. In hypokalemia, add potassium citrate.
Lactatacidosis
Lacatatacidosis is developing with lactate hyperproduction, reducing its metabolism or the other together.
Laktat is a normal glucose and amino acid metabolism. The most severe form of lactatacidosis, type A, develops with hyperproduction of lactate necessary for the formation of ATP in the styled tissues (deficiency 02). In typical cases, the excess lactate is formed with insufficient perfusion of tissues due to hypovolemic, heart or septic shock and even more increases due to the slowdown of lactate metabolism in poorly supplied with blood liver. Lacatacidosis is also observed during primary hypoxia due to pulmonary pathology and with various variants of hemoglobinopathy.
Lacatacidosis of the type in develops in the conditions of normal overall tissue perfusion and is a less dangerous state. The reason for increasing lactate products can be the local relative muscle hypoxia in their strengthened work (for example, during physical exertion, cramps, trembling in the cold), malignant tumors and the reception of some medicinal or poisonous substances. These substances include inhibitors of reverse transcriptase and Biguanides - Fenformin and Metformin. Although in most countries, Fenformin has been removed from sale, in China it is still applied.
The unusual form of lactatacidosis is D-lactatacidosis, due to the absorption of D of lactic acid (product of carbohydrate exchanging bacteria) in the colon in patients with eunoileal anastomosis or after the intestinal resection. This substance is preserved in the blood, since human lactate dehydrogenase destroys only lactate.
Diagnosis and treatment of lactacidosis of type A and are similar to those with other variants of metabolic acidosis. In D-lactatacidosis, anionic slot turns out to be less expected for the existing reduction in HCO 3 level; The appearance of osmolar slit in the urine is possible (the difference between the calculated and measured urine osmolarity). The treatment is reduced to infusion therapy, restricting carbohydrates and (sometimes) to the appointment of antibiotics (for example, metronidazole).
Acid-alkaline equilibrium in a healthy body is maintained at a constant level, blood has a weak alkaline reaction. Upon rejection of it towards the acidification, metabolic acidosis develops, alkalosis - alkalosis. The violation of the balance in the acidic side is more common, the doctors of all specializations face with it.
Adosis itself never arises, it always develops as a consequence of any violation or illness. The causes of acidosis are many: from diabetes to overdose ascorbins. In all cases, the processes in the body are similar: biochemical reactions slow down, the protein structure changes its structure. This state is very dangerous, up to the failure of organs and death.
Metabolic acidosis - what is it?
Proteins are present in each cell of our body. They are also in hormones, and in enzymes, and in the immune system. Amphoterne proteins, that is, they have properties of both acids and bases. They are performed in a rather narrow range pH: 7,37 — 7,43 . With any deviation from it, proteins irrevocably change its structure. As a result, enzymes lose activity, ion channels are destroyed, cell membranes cease to carry out their functions, refuse receptors, the transmission of nerve pulses is disturbed.
From such serious consequences, the body protects itself by independently using a buffer system of several levels. The main one is bicarbonate. In the blood, the salts of coal acid are constantly present, bicarbonates, which, with an increase in the blood of the acid, they immediately neutralize it. As a result of the reaction, coalic acid is formed, which decomposes on carbon dioxide and water.
The concentration of blood bicarbonates is maintained by the kidneys, there is a return process: the extra hydrogen ions are derived from the urine, and the bicarbonate returns to the blood.
If the acids in increased quantities come from outside or are formed in the body, acidosis develops. It is characterized by a drop of pH to 7.35 and below. The reason for the displacement of the acid-base equilibrium can be enhanced in the body of carbon dioxide, disorders in the kidneys with the cessation of work on the restoration of the bicarbonate reserve, excessive reasons for the bases through the gastrointestinal tract. Could cause acidification and distorted metabolic processes, in which case metabolic acidosis occurs.
Causes and factors of development
For the treatment of acidosis, not enough bicarbonates into the bloodstream. Moreover, in some cases, their introduction can be dangerous. To eliminate acidosis, it is necessary to understand, under the influence of which factors he began to develop.
Possible causes of metabolic acidosis:
- Insulina lack or strong. Because of this fabric, nutrition does not receive and are forced to use fats that are split to the formation of acids.
- Enhanced formation of lactic acid in diseases of the liver, insulin deficiency with diabetes, lack of oxygen in tissues due to diseases of vessels, lungs, hearts.
- Excessive alcohol consumption accompanied by vomiting and subsequent hungry period.
- Long fasting or strong excess fats in food.
- Inxication of the body when used: ethylene glycol - alcohol, antifreeze component; Salicylic acid is greater than 1.75 g per kg of weight; methanol.
- Poisoning of toluene pairs, which is contained in paints, varnish, glue, solvent.
- Reducing the functions of the kidney glomers due to nephropathy, pyelonephritis, nephrosclerosis, treatment with some drugs: anti-inflammatory funds; amphotericin - antifungal drug; Tetracycline - antibiotic; drugs lithium - psychotropics; acetazolamide (diakarb); Spironolactone (Veroshpiron) - diuretic.
- Losses of bicarbonates from the gastrointestinal tract due to diarrhea, outdoor fistulas.
- Overdose of metformin - the drug appointed with an insulin-dependent type of diabetes. Reception of metformin patients with disturbed work of the liver or kidney.
- Insufficient working of aldosterone or deoxycorterone adrenal cortex.
- Excess potassium in violation of its kidney removal.
- The introduction of acids in parenteral nutrition or ammonium chloride to remove swelling.
- Massive tissue necrosis due to long-term compression, burn, myopathy, and gangrenous changes in diabetes mellitus.
Types of disease
Depending on the cause of accumulation of acids in the blood, acidosis is divided into types:
| Type of acidosis | Violation | The reasons |
| Due to the lack of glucose, the body is forced to satisfy its needs due to the splitting of fatty acids. The process is accompanied by the enhanced formation of ketok acids. | Sugar diabetes: - Insufficient dose of insulin or spoiled drug, - strong insulin resistance due to a long lack of compensation. Long starvation, alcoholism. | |
| An increase in the concentration of dairy and pyruogradic acids. Their formation is enhanced with a lack of oxygen. | Easy shape - after load on the muscles, especially in incredible people. Heavy - for the diseases of the liver, which normally purifies blood from acids. It may be observed in diseases leading to oxygen starvation: heart, pulmonary, vascular, with a lack of hemoglobin. The probability of lactoacidosis increases the uncontrolled method of metformin during diabetes. | |
| Kneaking canaly | Acids are not formed. Acidity increases due to lack of bicarbonates. Proximal acidosis is a violation of the return of bicarbonates into blood. Distal - insufficient reduction of hydrogen ions. | Proximal acidosis - nephrotic syndrome, hepatic veins thrombosis, myeloma, cysts, long-term reception of diuretics, flawlock of aldosterone. Distal acidosis - pyelonephritis, nephropathy, taking medicines that can affect urine filtration rate in gloms. |
| Acidosis with intoxication | The acidification of decomposition products of substances, for example, oxalic acid when eating ethylene glycol or formic acid during methanol poisoning. | Non-compliance with safety equipment when working with poisonous substances, consumption of surrogate alcoholic beverages, an overdose of drugs. |
The combined form of acidosis is also found, especially in patients with chronic metabolic disorders. For example, the risk of acidosis due to high sugar during diabetes significantly increases alcohol consumption and.
According to the degree of compensation, acidosis is divided into 3 forms:
- compensated acidosis: Symptoms are rarely observed, acidity is close to the lower boundary of the norm, the state is stable. Special treatment is not required, it is necessary to identify and eliminate the cause of violation;
- subcompensated acidosis: border state, observation is required;
- decompensated form of metabolic acidosis - PH blood is reduced to life-threatening values \u200b\u200bor continues to decrease. Urgent hospitalization is required, the correction of acidity with special solutions, in some cases resuscitation measures. Without treatment, decompensated acidosis can cause someone and lead to the death of the patient.
Criteria for determining the degree of metabolic acidosis:
Symptoms and signs
From the point of view of pathophysiology, acidosis is a typical process accompanied by common symptoms. Compensated acidosis can be recognized only by changing the composition of blood and urine. Symptoms in the patient at this point are completely dependent on the disease that caused acidity displacement.
As the state exacerbates, the first general feature appears for all types of acidosis - reinforced, frequent breathing. It is explained by the increase in the content of carbon dioxide in the blood during the operation of the body buffer systems. When oxygen fasting tissues begins, shortness of breath occurs, breathing acquires a pathological form - becomes noisy, the pauses between the breaths are shortened, and then disappear.
With metabolic acidosis, there is a sharp emission of adrenaline and its predecessors, so the work of the heart is accelerated, because of what the pulse is rapidly, the blood release increases per unit of time, the pressure is growing. Gradually, cell membrane proteins lose some of the functions, hydrogen ions are part of the cells, and potassium leaves them. Calcium leaves, hypercalcemia appears in the bloodstream. Due to the excess of blood electrolytes, the symptoms change to the opposite: pressure drops, arrhythmia occurs. Such signs indicate that acidosis moved to a heavy stage.
Among often emerging symptoms can also be distinguished vomiting and diarrhea. They are caused by intoxication by ketones taken from outside substances or an increase in the tone of nerves, which leads to increased operation of the digestive glands and spasms.
Symptoms and the CNS are observed: the patient is immersed in a broken, sleepy condition, feels lethargy. Apathia can alternate with irritability and anger. At the increase in acidosis, the patient loses consciousness.
Signs characteristic of individual types of metabolic acidosis:
- for ketoacidosis typical of the smell of acetone from the skin and from the mouth in the patient, severe abdominal pain, the tension of the abdominal wall. In diabetes mellitus, ketoacidosis begins only at a high level of sugar, which is accompanied by thirst, and dry mucous membranes;
- the initial features of acidosis caused by the reception of drugs include a decrease in their effectiveness;
- when metabolic acidosis is accompanied by severe intoxication, uncharacteristic breathing may be observed in the patient - superficial, neulty;
- if the acidosis is caused by kidney disease, especially renal failure, there are often signs of hypocalcemia: heart fibrillation, muscle cramps. The patient's breathing may have a smell of ammonia;
- the increase in the formation of lactic acid with lactoacidosis is manifested by pain in the muscles that are amplifying during the load on them. If the cause of lactoacidosis was the problem with the lungs, the skin of the patient first sends, gradually blues and is covered later.
Acidose diagnosis
The diagnosis of acidosis is carried out in two stages. The first is determined whether the displacement of blood acidity and its type is available. The second reveals the reason caused by metabolic acidosis.
Acid-alkaline state, or pH of blood, oxygen content and carbon dioxide can be determined in laboratory conditions using a gas analyzer. Blood fence is made from radial artery, sometimes from the capillaries on the finger. The analysis takes no more than 15 minutes.
To determine the type of acidosis in most cases, sufficient studies on the level of glucose and lactate in the blood, ketone bodies in the urine:
| Diagnosis | Results of analyzes, mmol / l | |||
| Blood glucose | Ketone bodies | Blood lactate | ||
| Norm | 4,1-5,9 | do not detect | 0,5-2,2 | |
| Ketoacidosis | with noncompensated diabetes | >11 | >1 | norm |
| nediabietic | norm or a little higher | |||
| Lactoacidosis | norm | norm | > 2,2 | |
At the treatment stage, it is necessary to eliminate the violation that caused acidosis. To identify it, many studies can be carried out, depending on the disease diagnosed previously in patient and the clinical picture.
The main ones are common and various biochemical blood tests, a common urine analysis.
Possible deviations:
- Protein, kidney epithelium cells, cylinders in the urine, the growth of creatinine blood indicate the problems with the kidneys.
- Sugar in the urine testifies to its high level in its blood, most often due to diabetes or acute stage of pancreatitis.
- The growth of blood leukocytes suggests that acidosis arose due to inflammation and disorders of one of the internal organs. Neutrophils are increased in a bacterial infection, lymphocytes - with viral.
- An increase in bilirubin concentration or a decrease in blood proteins is observed in hepatic insufficiency, cirrhosis.
According to the results of the tests, ultrasound, computer or magnetic resonance tomography can be appointed. The volume of research is determined by the doctor, taking into account the intended cause of metabolic acidosis.
Methods of treatment
The first thing to do with the appearance of the above symptoms is to cause ambulance, as the metabolic acidosis is inefficient and deadly and deadly. Often, the recommended treatment of soda is absolutely useless. Sodium carbonate when inserted into the stomach will be completely neutralized with gastric juice, it will not be able to get a gram in the blood, therefore, its pH will remain unchanged.
In the hospital for the treatment of acidosis, first of all, they try to eliminate the cause, which caused it. Diabetes reduce blood sugar with intravenous insulin administration. In the case of undiabetic ketoacidosis, parenteral nutrition or dropper with glucose may be required. Dehydration eliminate with the help of volumetric injection of saline. If, when returning potassium into cells, its lack of blood occurs, potassium chloride is introduced. In renal failure and poisoning, the blood is cleaned with hemodialysis.
Intravenous administration of alkaline solutions are used as a last resort, as they can coagulate breathing, reduce pressure, worsen the effect of insulin, alkalosis may occur during overdose. Most often use sodium bicarbonate and thrometamol.
Sodium bicarbonate is used in severe metabolic acidosis, when the pH is reduced to 7.1, and low pressure in the patient. It can also be used in loss of carbonates through the digestive and overdose of drugs. The required amount is calculated by the formula. The solution is introduced slowly, under constant control of blood composition.
Thrometamol is able to associate a greater number of hydrogen ions, and not only in the blood, but also inside the cells. This drug is used in cases where long-term acidosis can be dangerous for the heart of the patient. The prerequisite for the introduction of thrometamol is the normal work of the kidneys.
If the treatment was carried out in a timely manner and managed to avoid complications, the acidosis is eliminated in the first day, and after a week the patient will be discharged.
For the normal operation of the body, it is necessary to maintain all its functions in the equilibrium state. This applies not only to the level of hormones, the activity of sympathetic and parasympathetic nerve systems, but also an acid-alkali composition of blood. Normally, the amounts of substances with low and high acidity (abbreviated pH) are in a specific balance sheet. Due to this, blood has a weakly alkaline environment. With an increase in the concentration of alkalis, the person develops "alkalosis", with an increase in acids - "acidosis".
Metabolic acidosis develops with various diseases that are not associated with the lesion of the respiratory system. Itself can not arise and is always a complication of any other disease. All the necessary information about the reasons, symptoms and methods of treating this state you can get from this article.
What is dangerous acidosis
This is a difficult complication that may occur due to severe infections, against the background of diabetes, with violation of the functions of the liver, kidney and under a number of other pathologies. The "acidification" of blood causes a number of additional disorders in the work of organs and tissues, among which the most dangerous is:
- Defeat cells throughout the body. A large number of free acids corps the outer shell of the cells, which leads to a violation of their functions. Since toxins are spread to all organs and tissues, pathological changes can be very diverse;
- Respiratory disorders. Oxygen in the body is alkali, in its chemical role. Therefore, for patients, a deep frequent breathing is characterized - so the body is trying to reduce acidity. Unfortunately, this process leads to a narrowing of cerebral vessels and an increase in blood pressure. As a result, the human condition is only worsening and increases the risk of hemorrhages in various organs;
- Raising blood pressure. The mechanism of occurrence is associated with the presence of respiratory disorders;
- Damage to digestive organs. In most patients, acute metabolic acidosis causes pain in the abdomen, stool disorders and other dyspeptic phenomena. With this violation, such aggressive substances such as acetone and oxyma salted acid are often formed, which corrupt the gastric mucosa, esophagus and intestines. In some cases, patients even have bleeding from these organs;
- Depression of consciousness. The toxins produced by the body negatively act on the nerves and brainstuffs. With a slight course, the patient may have irritability, weakness, drowsiness, and during severe - coma;
- Disturbation of the heart. Damage to the cells and nervous tissue, the imbalance of trace elements and a number of other factors inevitably affect myocardium. At the first stages, this influence can manifest itself with frequent and strong heartbeat, rhythm disorders. With severe pathology, cardiac abbreviations weaken and become stronger. The final stage is the stop of the heart.
All listed violations can not only worsen well-being, but also carry a threat to life. That is why the first signs of the disease must be detected and treated as early as possible.
Types of metabolic acidosis
Diagnose a specific form of pathology is very important - this allows not only to find out the reason for its development, but also to determine the optimal medical tactics. At the moment, doctors use 2 major classifications that help to diagnose.
The first reflects the connection with diabetes. To find out the presence of the patient this disease is necessary before starting treatment, since metabolic acidosis in diabetes has its own characteristics. His therapy necessarily includes the correction of the level of glucose (sugar). Without this nuance, any other healing procedures will be ineffective.
The criterion of the second classification is the type of body poisoning. In the blood of a person, various acids can increase, the most dangerous of which are lactic acid and ketone bodies (acetone, oily acids). Depending on the "obsessing" substance allocate:
- Ketoacidosis. In the patient's blood, there is oxymalaic acids and acetone. Often develops against the background of diabetes, but may occur under other diseases;
- Lactate acidosis. Accompanied by an increase in the concentration of lactic acid. May occur with a large number of diseases, including due to violation of the liver or kidney, the development of severe infection, with poisoning, etc.;
- Combined form. Often it is found in people with an elevated sugar level and in the presence of provoking factors. The latter may include pronounced stress, physical overload, infectious diseases and a number of other states.
The causes of the occurrence of various forms are somewhat different from each other. They need to know to quickly assume the type of disease and properly treat metabolic acidosis.
The reasons
As mentioned above, this pathology does not arise in itself. This is always a consequence of another disease, which leads to disruption of metabolism and accumulation of toxins. Mechanisms and causes of metabolic acidosis differ in various forms. All the necessary information on this issue is presented in the table below.
| View | The reasons | The mechanism of development of pathology |
| Diabetic ketoacidosis | This form occurs in patients with diabetes, the flow of which has taken more severe nature. The following factors may result in this:
|
The main manifestation of diabetes is a violation of the control of the body behind the level of glucose. Due to damage to certain receptors or insulin disadvantage, the body cannot determine the level of sugar, after which it constantly increases its number. The release of glucose into blood occurs when fats and proteins are cleaving. The by-products of this chemical reaction are toxic acids - acetone and oxyma salted acid. Their accumulation leads to a change in blood acidity. |
| Nediabetic ketoacidosis | This condition may occur in case of insufficient flow of carbohydrates into the body or with impaired absorption. Nediabetic ketoacidosis develops at:
|
The lack of carbohydrates in the blood and tissues leads to a shortage of energy in all organs. If there are no carbohydrates - the body takes the energy from the splitting of proteins and fats. This leads to the release of toxic substances and the development of ketoacidosis. |
| Lactat-acidosis |
|
A certain amount of lactic acid is constantly produced in a healthy body. A significant increase in its quantity can occur in the violation of its release (for example, in damage to the kidneys), disorders of metabolism or in sufficient oxygen delivery in tissue. The latter situation may arise due to the lesion of oxygen carriers (erythrocyte) cells or in some hereditary metabolic disorders. |
Some doctors additionally allocate a hyperchloremic form, which arises together with lactate-acidosis. However, according to the information of modern scientific publications, chlorine exchange disorders are less significant. They practically do not affect the tactics of treatment, so they are now not distinguished in a separate appearance.
Symptoms
This condition does not have any characteristic features. The change in acidity is accompanied by a large number of different symptoms, which is quite difficult to associate with each other. That is why identify the disease in the home condition is quite difficult.
To general manifestations that can observe with any form of the disease include:
- Constant nausea with vomiting, after which does not occur improvement of well-being;
- A sharp weakness that forces the patient to be in bed;
- The appearance of shortness of breath is at rest. A person cannot "imagine", because of which his breathing becomes frequent and deep;
- The pallor of the skin and visible mucousse (eye, oral and nasal cavity);
- The appearance on the skin of the cold sweat;
- Slowdown in heartbeat and decrease in blood pressure;
- It is possible to develop cramps, strong dizziness and loss of consciousness (up to coma).
As we have said, the change in acidity does not occur by itself. This state is always preceded by any other disease. It can be said simplifying that a sharp deterioration in state of health against the background of the disease is often the first symptom. In this case, it is necessary to call an ambulance brigade, which will assess the situation and, if necessary, hospitalizes the patient. The doctor's hospital will establish a final diagnosis, will conduct the necessary research and therapeutic measures.
Diagnostics
Conditionally, all studies are conducted with three goals: assess the level of blood acidity, determine the type of pathology and find out the causes of pathology. For the first purpose, it is enough to carry out a single study - the determination of the acid-alkaline state. To find out the cause of the pH change, much more diagnostic events may be required.
Acid alkaline blood test
The easiest and most reliable way to confirm the presence of metabolic acidosis is to carry out this analysis. This does not require any special preparation from the patient. As needed, the patient take blood from the vein, which is sent to the laboratory. As a rule, the finished result can be obtained within a few hours.
To decrypt the results, you need to know the normal values \u200b\u200bof the indicators and their deviations for the disease. This information is presented in the table below:
| Indicator | Norm | Changes in metabolic acidosis | It is important to pay attention |
| pH (acidity) | 7,35-7,45 | There is a decrease in pH |
At pH 7.35-7.38 and the presence of symptoms - the diagnosis of compensated metabolic acidosis is diagnosed. the pH is less than 7.35 indicates the development of decompensated acidosis. |
| RAO 2 reflects the amount of blood cells contained in the blood. | 80-100 mm.rt.st. | There are no changes or an increase in RAO 2 is observed. | If against the background of reduced acidity, an increase in the concentration of carbon dioxide and the decrease in oxygen is noted - it is a respiratory, not metabolic acidosis. |
| Raso 2 shows the amount of blood carbon dioxide. | 35-45 mm.rt.st. | There are no changes or a decrease in RAS 2 is observed. |
This analysis is sufficient to confirm the presence of pathology. However, to clarify its shape and causes of development it is necessary to conduct a number of additional studies.
Determination of the type of pathology
For this purpose, the doctor prescribes a patient a general analysis of urine and a biochemical blood test, which necessarily comprises determining the level of glucose and lactic acid. These two studies allow you to quickly determine the specific type of disorders of the acid-alkaline state.
Determination of the cause
In order to clarify the causes of the doctor, a large number of different studies may be prescribed, depending on their assumptions. However, there are analyzes that are necessarily carried out by all patients with this disease. They allow us to assess the condition of the main organs and systems with the lowest costs. This "diagnostic minimum" includes:
| Study | Norma | Possible changes |
| Clinical blood test |
Soe - up to 15 mm / hour Leukocyte level 4-9 * 10 9 / liter. Including:
|
A significant increase in the level of ESP and leukocytes may be marked against the background of the infectious process.
|
| General urine analysis |
Density 1015-1026; Blood cells (leukocytes, erythrocytes) 2-3 in sight; Protein - less than 0.03 g / l; Cylinders - absent; Glucose is missing. |
Reducing the density of urine and the appearance of pathological impurities (cells, cylinders, etc.) may indicate renal failure - one of the frequent causes of lactate acidosis. |
| Biochemistry of blood |
Total protein 65-87 g / l; Alt 7-45 Me; AST 8-40 Me; Common bilirubin 4.9-17.1 μmol / l; Creatine 60-110 μmol / l. |
The increase in bilirubin and hepatic enzymes (ALT, AST) often indicates acute liver damage. The excess of the Creatine rate is usually a sign of severe renal disease or the development of chronic kidney disease (abbreviated - HBP). Reducing the general protein with a minor increase in other indicators may be a sign of chronic liver pathology, such as cirrhosis or chronic hepatitis. The multiple increase in the total protein is an indirect sign of myeloma disease. |
In addition to the indicated laboratory diagnostic methods, the doctors can recommend ultrasound, magnetic resonance or computer tomography, scintigraphy of individual organs and a number of other procedures. The decision on the required amount of research is determined individually, depending on the intended cause of acidity reduction.
Principles of treatment
The correction of metabolic acidosis is a rather difficult task even for an experienced doctor. Each patient with suspicion of this disease is offered to be hospitalized, since they need continuous observation, regular intravenous infusion of solutions and periodic conducting various studies.
All treatment objectives can be divided into two groups - restoration of normal acid acidity and elimination of the cause of pathology.
RN.
First of all, the doctors are trying to figure out what disease led to the development of pathology. If it is diabetes - immediately begins the therapy to reduce glucose levels using insulin and pharmacopreratics. In the development of severe infection - a comprehensive treatment is carried out using antibacterial / antiviral drugs. If the decrease in the pH caused a strong damage to the organ - the attending physician tries to restore its function or replace them with drugs and instrumental techniques (for example, hemodialysis).
Simultaneously with the measures listed above, infusion therapy is necessarily carried out - drip intravenous infusion of solutions. The choice of solution is carried out depending on the type:
| Form of pathology | Features of infusion therapy | Optimal solutions |
| Diabetic ketoacidosis | In patients with this condition, it is necessary to fill the loss of fluid and useful trace elements. In this case, solutions containing glucose are contraindicated to use. | Preparations containing electrolytes: potassium, sodium, calcium, magnesium, etc.
|
| Lactat-acidosis | The main goal of therapy is to eliminate the lack of fluid, a decrease in the concentration of lactic acid and the restoration of alkalis deficiency. | |
| Nediabetic ketoacidosis | With this form, solutions with anti-flame effect are shown. In addition, they must comply with glucose deficiency (if there is any) and fluid. |
The optimal preparation for therapy (in the absence of contraindications) is a 20-40% glucose solution. Additionally, it is possible to use the preparations of reosorbilact and xylate, which effectively eliminate acetone and oil acids from the blood. |
Infusion therapy in children is carried out according to the same principles as in adults. The main thing is to correctly determine the cause and option of the disease. The only difference lies in the volume of intravenous injections - the child requires a significantly smaller amount of liquids. Doctors calculate the required amount by body weight.
Features of therapy of individual forms
Since each of the forms have different pathological mechanisms, some moments of their treatment differ from each other. In this section, we present the most important principles that need to be guided when appointing therapy:
- With lactate-acidosis, in addition to infusion therapy, vitamins of groups B (thiamine, pyridoxin, cyanocobalamin) are prescribed every 12 hours. These substances improve the metabolism and contribute to the normalization of acidity. To combat air deficiency, patients conduct constant oxygen inhalation through a mask or nasal cannula. With severe acidosis, when the level of lactic acid rises in 4-5 times the doctors can conduct "purification" of blood - hemodialysis;
- With ketoacidosis without diabetes, as a supplement to standard therapy, it is recommended to assign drugs that restore the operation of the digestive system (domperidone, methoclopramide). This will reduce fluid losses with vomiting and improve food digestion. Power must be carried out through the mouth (using a gastric probe or frequent fractional feedings). It should be a caloriest, with a high content of carbohydrates and a low concentration of fats. Also, patients are shown by vitamin therapy;
- In diabetic ketoacidosis, the main method of treatment is the introduction of insulin. Reducing sugar concentration and sufficient intravenous injections are the most efficient ways of therapy. After these events, in most cases, the pH is restored to normal values \u200b\u200band the patient's well-being improvement occurs.
The child's treatment is carried out according to the same principles as the therapy of an adult patient. However, it should be remembered that children are harder to carry any diseases, and especially those that are accompanied by a change in acidity. Therefore, timely hospitalization and proper medical care are especially important for them.
FAQ
It depends on the cause of the disease. In the presence of a patient with diabetes, it is prescribed a table without easily friendly carbohydrates and with a predominant number of protein food. With a low level of glucose (against the background of an undiabetic ketoacidosis) on the contrary, carbohydrates should be the main component of food to compensate for the lack of energy.
Question:
How long will the treatment of this disease take?
Depends on the severity of the disease and the state of the patient itself. The minimum term of therapy, in most cases, is 2 weeks.
Question:
What are the most frequent causes of acidosis in newborns?
In the overwhelming majority, this state develops at various intrauterine pathologies, which lead to oxygen starvation of the child and violate the flow of nutrients through the placenta. The reason for the premature detachment of the placenta, transferred pregnancies, premature genera, pathologies of umbilical cord, etc. It may occur both ketoacidosis and accumulation of lactate. Treatment of such children is carried out according to the same principles that have been described above.
Question:
Is it possible to develop complications after suffering from the disease?
Reducing blood pH in itself can cause severe brain damage, heart or kidney. It should also be remembered that caused by its disease can lead to the defeat and other organs.
Question:
Are there any distinctive symptoms of ketoacidase and lactat-acidosis?
Of the characteristic features it is necessary to note two: the appearance of the smell of acetone and the rate of development of coma. The occurrence of a specific smell of the patient's skin is characteristic only for ketoacidosis, while the patient with a violation of the maminous acid exchange smells normally. By the time of development of coma, it is also possible to assume a disease of the disease - with lactat-acidosis, most often the violation of consciousness is rapidly (within a few hours). While the patient with an elevated content of ketone bodies in the blood consciousness can be maintained for 12-20 hours.
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Acidosis is one of the forms of disorders of the acid-alkaline equilibrium, in which the internal medium is acidified due to the accumulation of acidic products and hydrogen ions. Normally, these products are quickly removed due to the operation of buffer systems and isolation organs, but under a number of pathological conditions, pregnancy, etc. Acid products accumulate, penetrate into the urine and are able to lead to a coma.
Excess acids appears with excessive products or disability, leading to a decrease in pH and the development of acidosis, which is not an independent disease, but only reflects the development of another pathology and is considered one of the possible complications.
Norma is 7.35-7.38. Deviations from this value are fraught with serious violations in homeostasis, the work of vital organs and can even threaten their lives, so the indicator is very carefully monitored in the severe pathology of the internal organs, in patients of resuscitation departments, cancer, in pregnant women predisposed to such disorders.
Excess acidic products can be absolute or relative, compensated or noncompensated. The short-term pH fluctuations are also normal, reflecting the intensive metabolism, the impact of stressful factors, etc., however, acid-alkaline equilibrium quickly comes to normal due to the well-coordinated work of buffer systems, kidneys and lungs. Symptoms such acidosis do not have time and therefore fit into the framework of the physiological adaptive mechanism.
The acidification of the inner medium can be chronically occurring in the diet's errors, which are prone to many people and young, and mature age. This type of acidosis is lifelong, without causing pronounced symptoms or violation of life. In addition to food, the acidity of the inner medium is influenced by the quality of drinking water, the level of physical activity, psycho-emotional state, hypoxia due to lack of fresh air.
The determination of the blood pH level is not among the required variability parameters. It is clarified by the appearance of symptoms of disorders of acid-alkaline equilibrium, most often - in patients of resuscitation departments and intensive care chambers. It is necessary to treat acidosis immediately, since the decrease in the pH is fraught with heavy brain activity disorders, a coma and patient's death.
Causes and varieties of acidosis
It is important to remember that acidosis is only one of the symptoms, in which the clarification of the true cause of the violation is a primary task for specialists.
The causes of acidosis can be:
- Diseases leaking with increasing body temperature;
- Pathology kidney;
- Continuous diarrhea;
- Fasting or unbalanced nutrition;
- Pregnancy state;
- Violation of pulmonary ventilation in inflammatory processes, cardiac pathology;
- Endocrine-exchange disorders (diabetes mellitus, thyrotoxicosis).
Increased body temperature that accompanies diverse pathology Both infectious and noncommunicable nature is accompanied by the intensification of metabolism and the production of special protective proteins - immunoglobulins. In case the temperature exceeds 38.5 degrees, the metabolism changes towards catabolism, when the disintegration of proteins, fats and carbohydrates increases, the result of which becomes the inner medium.
Pregnancy - the particular condition of the body of the future mother, many of the organs of which are forced to work in reinforced mode. Ensuring the fetus with nutrients and oxygen requires an increase in the level of exchange, while the decay products become more not only at the expense of its own, maternal, but also at the expense of those that highlight the fetus growing in the uterus.
Insufficient flow of nutrients - Another important factor provoking acidosis. In fasting, the body seeks to ensure itself with the energy of the existing reserves - fatty fiber, the glycogen of the liver and muscles, etc. The decay of these substances implies the disorder of acid-alkaline equilibrium with the shift of the pH towards the acidification due to the overaffect of the formation of acidic products by the organism itself.
However, not only the absence of food, but its incorrect composition also contributes to the growth of chronic acidosis. It is believed that animal fats, salt, carbohydrates, refined products while simultaneously lacking fiber and trace elements contribute to the development of acidosis.
An essential acid alkaline equilibrium shift can occur with respiratory disorders. With a decrease in the volume of pulmonary ventilation in the blood, the excess amount of carbon dioxide occurs, which will inevitably lead to acidosis. Such a phenomenon can be observed in the edema of lightweight, severe respiratory failure against the background of emphysema or asthma, pneumonia - respiratory acidosis.
Depending on the pathogenetic mechanism for the development of acidosis and the degree of violation of the organs, there are several varieties Acidoza. By the meaning of the pH, it happens:
- Compensated - when acidity does not go beyond the extreme lower boundary of the norm, equal to 7.35, and the symptomatics is usually absent;
- Subcompensated - pH decreases even more, reaches 7.25, there are signs of dysmetabolic processes in myocardium in the form of arrhythmias, as well as shortness of breath, vomiting and diarrhea;
- Decompensated - the index of acidity becomes below 7.24, disorders from the side, heart, digestive system, brain, up to the loss of consciousness are expressed.
According to the causal factor distinguish:
- Gas acidosis - the reasons for it can consist in a violation of the pulmonary gas exchange (the pathology of the respiratory organs) and then it will be called respiratory (respiratory), as well as in the change in air composition with excess carbon dioxide, hypoventilation in injuries of the chest, etc.;
- Negazova;
- Metabolic acidosis - develops in violation of metabolic processes, the impossibility of binding or destruction of acidic blood components (diabetes mellitus, etc.);
- Excretory (excretory) - in case the kidneys are not able to remove the acid from the body dissolved in the blood (renal), or from the intestine and the stomach is lost greater than normal, the number of alkalis - gastrointestinal variety;
- Exogenous - upon admission from outside a large number of acids or substances capable of transforming into acid in the process of biochemical reactions in the body;
- Mixed option The acidification of the inner medium in which the combination of several mechanisms for the development of pathology takes place. For example, diseases of the heart and lung, lungs and kidneys, diabetes and simultaneous damage to the kidneys, lungs, intestines, etc.
Metabolic acidosis
A metabolic acidosis is considered to be one of the most common forms, in which the concentration of dairy, acetoxus and β-hydoxymacal acids increases in the blood. It proceeds heavier than other varieties, accompanied in the blood and reduced hemoperfusion in the kidneys.
metabolic acidosis
Sugar diabetes, thyrotoxicosis, starvation, alcohol abuse, and other causes, and depending on the type of acid, preferably accumulating in the body, is a lactic acid acidosis (lactatacidosis) and ketoacidosis characteristic of diabetes mellitus.
In case of lactic acid, acidosis in the blood increases, with ketoacidosis - the products of the exchange of acetoacetic acid. Both varieties may have a serious flow during diabetes and lead to a coma that requires immediate qualified assistance. Rarely lactat-acidosis develops with excessive physical exertion, especially, people who do not engage in sports are regular. Milk acid accumulates in muscles, causing pain, and in the blood, overlooking it.
Manifestations of acidosis
The symptoms of acidosis depends on the degree of pH shift in the acidic side. In the case of compensated forms of pathology, the light flow of symptoms does not arise either they are small and barely noticeable, however, when the amount of acidic products, weakness, fatigue, will change, the breathing and coma will change.
The symptoms of acidosis can be disguised by the manifestations of the main pathology or it is very similar to it, which makes it difficult to diagnose. Easy acidosis is more often asymptomatic, heavy - always gives the clinic of disturbed respiration, it is possible to reduce the reduction of the heart muscle and the reaction of the peripheral vascular bed to adrenaline, which entails a cardiogenic shock and to whom.
Metabolic acidosis It is accompanied by a very characteristic respiratory disorder according to the type of Kussmouul, which is directed to the restoration of acid-alkaline equilibrium by increasing the depth of respiratory movements, in which a larger amount of carbon dioxide is emitted into the surrounding air.
With respiratory (respiratory) acidosis, caused by a decrease in alveolar gas exchange, breathing will become superficial, possibly - even rapid, but will not deepen, since the alveoli is not able to provide an increased level of ventilation and gas exchange.
respiratory acidosis
The most accurate information on the concentration of carbon dioxide in the patient's blood, which the doctor can get without the attraction of additional methods of examination gives an assessment of the type of breathing. After it became clear that the patient really is acidosis, the specialists have to figure out his cause.
The smallest diagnostic difficulties occur during respiratory acidosis, the reasons for which is usually recognized quite easily. Most often, obstructive emphysema, pneumonia, interstitial edema of the lungs act as trigger. To clarify the causes of metabolic acidosis, a number of additional research is carried out.
Moderately pronounced compensated acidosis takes place without any symptoms, and the diagnosis is to study the buffer blood systems, urine, etc. When the severity of the pathology changes the type of breathing.
With the decomposition of acidosis, violations of the brain, heart and vessels, the digestive tract associated with the ischemic-dystrophic processes against the background of hypoxia and the accumulation of excess acids are occurring. The increase in the concentration of the hormones of the brain layer of the adrenal glands (adrenaline, norepinephrine) promotes tachycardia, hypertension.
The patient with an increase in the formation of catecholamines is experiencing heartbeat, complains of the increase in the pulse and blood pressure fluctuations. As the acyondment aggravation can join the arrhythmia, often developing bronchial spasms, the secretion of the digestive glands is intensified, therefore vomiting and diarrhea can be among the symptoms.
The effect of the acidification of the inner medium on the activity of the brain provokes drowsiness, fatigue, inhibition of consciousness, apathy, headaches. In difficult cases, the violation of consciousness is manifested by a coma (with diabetes mellitus, for example), when the patient does not respond to external stimuli, pupils are expanded, breathing rarely and superficial, muscle tone and reflexes are reduced.
When respiratory acidosis, the appearance of the patient changes: The skin changes painting with cyanotic back to pinkish, is covered with sticky sweat, the facedness appears. In the early stages of respiratory acidosis, the patient can be excited, euphoric, talked, but as acidic products accumulate in the blood, the behavior changes towards apathy, drowsiness. Decompensated respiratory acidosis proceeds with the opposite and a coma.
The increase in the depth of acidosis in the pathology of the respiratory organs is accompanied by hypoxia in tissues, a decrease in the sensitivity to carbon dioxide, the oppression of the respiratory center in the oblong brain, while the gas exchange in the parenchyma of the lung is progressively declining.
A metabolic is joined to the respiratory mechanism of disorders of acid-alkaline equilibrium. The patient enhances tachycardia, the risk of heart rhythm disorders increases, and if not starting treatment, then a coma has a high risk of fatal outcome.
If the acidosis is caused by uremia against the background of chronic renal failure, then there may be cramps associated with falling concentration. With increasing in the blood, the lack of breathing will become noisy, a characteristic ammonium smell will appear.
Diagnosis and treatment of acidosis
The diagnosis of acidosis is based on laboratory studies of the composition of blood and urine, determining the pH of the blood, assessing the effectiveness of the buffer systems. Reliable symptoms that make it possible to accurately judge the presence of acidosis, no.
In addition to lowering blood pH to 7.35 and below, are also characteristic:
- An increase in the pressure of carbon dioxide (in respiratory acidosis);
- Reducing standard bicarbonate and base indicators (with a metabolic embodiment of acid-alkaline equilibrium).
The correction of the lung forms of acidosis is carried out by appointing abundant drinking and alkaline liquids, products contributing to the formation of acid metabolites from the diet. Mandatory comprehensive examination to determine the cause of the RN shift.
Recently, the theory was widely disseminated, according to which a variety of pathological processes are associated with the acidification of the inner medium. Adherents of alternative medicine urge to use the usual food soda as a universal medicine from all diseases. However, it is necessary to first figure it out, is it useful and is it really harmless for a patient wondering than a person's ordinary soda?
In the case of malignant tumors, the treatment of soda will not have the necessary effect and even hurts, with gastritis - existing secretory disorders will aggravate and, it may provoke atrophic processes in the mucous membrane, and with alkalosis, it will contribute to the normalization of acid-alkaline equilibrium, but only under the condition of adequacy Doses, reception mode and permanent laboratory control of the level of pH, base bases and bicarbonate.
Pathogenetic treatment of acidosis consists in the elimination of the main pathology that caused the pH shift in the acidic side, - respiratory failure, edema of light, diabetes mellitus, Uremia, etc. For this purpose, bronchopholics are prescribed (beta-adreminometrics - Salbutamol, Salmetterol, Isoprenaline, Theophyllin) , Mulcolics and expectorant (acetylcysteine, ambroxol), antihypertensive drugs (enalapril, captopril), the dose of insulin in diabetes is adjusted. In addition to drug support, the respiratory tract is carried out and the positional drainage of the bronchi to restore their passability.
Symptomatic therapy for the normalization of acid-alkaline equilibrium is the use of soda and abundant drinking. In the case of decomposed acidosis and coma, sterile sodium bicarbonate solution is administered intravenously under constant control of acid-alkaline blood equilibrium and in resuscitation conditions.
The body is a very complex system consisting of various parts: organs, tissues, cells. And if a failure occurred at some level, the functioning of the entire body will certainly be impaired.
For example, if the number of acids (they are certainly present in tissues, blood) will increase, then the acidosis will arise. And what are his symptoms? And how should effective treatment be carried out?
Acidosis is not an independent disease, but a condition that occurs as a result of a disorder of the acid-alkaline balance of the body.
Each organism contains acids, they are necessary for its operation. And in the normal state, these most acids should be output, which provides balance.
But if this for some reason does not happen, they will accumulate in the blood, in the urine and even in some organs. This will certainly tell the alarming symptoms. It is worth noting that treatment should be timely, since strong oxidation is not normal, it can lead to sad consequences.
Several varieties of such a disease are distinguished. For example, if you take a condition for the development mechanism, the following types can be distinguished:
- Respiratory acidosis occurs due to insufficient removal of carbon dioxide during breathing. It turns out that it accumulates in the blood and changes its composition.
- Unpiratoric acidosis arises due to the accumulation of non-volatile acids in the blood, which for some reason are not derived, but remain in the body.
There is also a mixed form at which carbon dioxide and non-volatile acid accumulate.
Uncredit acidosis can also be classified:
- Metabolic. This is the most common and at the same time complex form at which endogenous acids begin to accumulate in the tissues of the body, violating their functioning. The symptoms are most pronounced, immediate treatment is required.
- Excretory. It occurs in case of violation of the excretory function of the body, for example, with renal failure.
- Exogenous. Its main reason is the admission to the body of an excessive amount of such substances, which in the process of processing are converted into acid and begin to accumulate, not the time to be output.
Depending on the concentration of acids (it is determined by the level of pH) allocate:
- With the value of the pH level close to the lower boundaries of the norms, compensated acidosis is diagnosed. With this state, a person may not suspect a long time about such changes, but they will be gradually (sometimes for several years) to disrupt the work of the body.
- With insignificant exceeding normal values, we are talking about subcompensated form.
- With a significant exceeding the norms, they are talking about decompensated form. Usually, the symptoms are obvious, the consequences can be sad, so immediate and competent treatment is required.
The reasons
Such a condition cannot develop unprepaid. There are many negative factors that can provoke an acid-alkaline balance disorders:
Manifestations
The symptoms of such a disease as acidosis, with a light form of the disease or at the initial stage, may not be manifested and not disturbed. And sometimes they are expressed only in the signs of the underlying disease, which led to the accumulation of acids and the development of this state.
But the manifestations are important to recognize on time to begin treatment and avoid heavy consequences, one of which is coma, and later death.
That's what symptoms should alert:
Diagnostics
It is possible to identify acidosis using blood and urine tests, as their composition will certainly change.
How to treat?
With such a disease, such as acidosis, immediate treatment is required, since in difficult cases there is a fatal outcome. So if there is alarming symptoms, immediately consult a doctor.
Here are basic measures:
- Elimination of the cause of the state development, that is, the treatment of the main disease or elimination of pathologies. For example, in diabetes, insulin is required. If the ventilation of the lungs is broken, it will be artificially carried out. Drainage of lungs, the removal of sputum (suction) and reception of expectorant drugs will be required.
- It is necessary to comply with a specific diet. The patient should use more berries, vegetables, fruits, cereals, vegetable products. And from strong tea and coffee, alcohol, roasted, flour, smoked, pickled, sweet and salty, it is worth abandoning.
- Blood should be cleaned of toxins and acids. It may be necessary plasmferres.
- In some cases, dialysis is effective.
- In severe forms, fluid is introduced intravenously, as well as sodium bicarbonate. If the patient can drink independently, he should do it. Effective by the technique of soda dissolved in water.
- If necessary, symptomatic treatment is carried out.
Acidosis is curable if measures are timely. Health to you!
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