Acidosis Variants, Signs, Consequences, and Management
Acidosis, a condition characterised by an excess of acid in the body, can lead to serious health complications. In this article, we will explore the different types of acidosis, their common causes, symptoms, and treatments.
1. Metabolic Acidosis
Metabolic acidosis is caused by excess acid production, decreased acid excretion, exogenous acid intake, increased acid production without tissue hypoxia, loss of bicarbonate, or chronic renal failure. Symptoms include rapid breathing, fatigue, confusion, headache, lethargy, nausea, vomiting, shock, and arrhythmias in severe cases. Treatment involves correcting the underlying cause, bicarbonate therapy in select severe cases, supportive care for respiratory compensation, and dialysis in kidney failure.
2. Renal Tubular Acidosis (a subtype of metabolic acidosis)
Renal tubular acidosis is caused by dysfunction in renal tubule bicarbonate reabsorption or acid secretion. Symptoms include growth retardation in children, muscle weakness, bone pain or fractures, and polyuria. Treatment involves alkali therapy with bicarbonate or citrate salts to neutralize acidosis and treatment of the underlying cause if identified.
3. Respiratory Acidosis
Respiratory acidosis is caused by hypoventilation, leading to CO2 retention. This can be due to acute or chronic lung diseases, respiratory depression from drugs, or neuromuscular disorders impairing ventilation. Symptoms include headache, confusion, drowsiness, shortness of breath, cyanosis in advanced cases, and rapid heart rate, arrhythmias. Treatment involves improving ventilation, treating the underlying pulmonary or CNS cause, and avoiding respiratory depressants.
4. Diet-Induced Acidosis
Diet-induced acidosis is caused by starvation or chronic malnutrition, alcoholism, or high protein diets. Symptoms include mild acidosis symptoms like fatigue and nausea, dehydration, and ketosis breath odor. Treatment involves nutritional support, carbohydrate refeeding, and addressing alcohol use disorder if relevant.
5. Drug-Induced Acidosis
Drug-induced acidosis can be caused by biguanides, salicylate overdose, ethylene glycol and methanol poisoning, some anticonvulsants and antiretrovirals, or drugs causing renal tubular damage. Symptoms depend on the toxin and may include vomiting, altered mental status, abdominal pain, and signs of poisoning like metabolic acidosis with high anion gap and abnormal urine findings. Treatment involves immediate cessation of the offending agent, supportive care and detoxification, hemodialysis in severe poisoning, and correction of acid-base and electrolyte abnormalities.
In summary, understanding the different types of acidosis, their common causes, symptoms, and treatments is crucial for targeted diagnosis and effective management. If you experience any symptoms of acidosis, it is essential to seek medical help immediately, especially for severe symptoms such as difficulty breathing. A balanced diet, regular exercise, and maintaining good health can help prevent acidosis.
[1] Goldman L, Ausiello D. Cecil Medicine. 25th edition. Elsevier; 2016. [2] Tishler M, et al. UpToDate. Renal Tubular Acidosis: Clinical manifestations, diagnosis, and management. 2020. [3] Marini JJ, et al. UpToDate. Respiratory Acidosis: Clinical manifestations, diagnosis, and management. 2020. [4] Smith JP, et al. UpToDate. Metabolic Acidosis: Clinical manifestations, diagnosis, and management. 2020. [5] Kellum JA, et al. Critical Care Medicine. 48(1 Suppl): S51-S60. 2020.
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