Metabolic acidosis: 
The signs will depend on the underlying cause. Usually there will be a rapid breathing (tachypnoea), lethargy and confusion with a headache. Severe disease can progress to shock or death. There is a fruity smell from the ketones of diabetic acidosis [6].

Respiratory acidosis:
Presenting signs can include lethargy or fatigue, shortness of breath, confusion and sleepiness [7].

• Fatigue

  Hypercapnia typically occurs late in the disease process with severe pulmonary disease or when respiratory muscles fatigue. (See also Pediatric Respiratory Acidosis, Metabolic Acidosis, and Pediatric Metabolic Acidosis .) [emedicine.com]

  We are reporting here a case of 16-year girl who presented with generalised fatigue and shortness of breath, and blood pressure (BP) of 220/110 mmHg. [ncbi.nlm.nih.gov]

  The Merck Manuals list symptoms of mild metabolic acidosis that include fatigue, nausea, vomiting, and an increase in breathing rate and depth that occur when your body tries to counter the effects of acidosis by purging carbon dioxide. [livestrong.com]

  If they should fatigue and lose the ability to hyperventilate, their pH would drop. It is important to reverse the acidosis before the patient may fatigue or develop respiratory failure (e.g., due to aspiration or pulmonary edema)(2). [emcrit.org]

• Collapse

  It is most often the result of lactic acid accumulation due to circulatory collapse but there are many other causes. A recently published case history describes metabolic (lactic) acidosis occurring in a 42-year-old man. [acutecaretesting.org]

  […] the mainstream in a reaction set in motion by the opening chords of smells like teen spirit from Kurt Cobains amplifier; not only this, the rock that remained was well beyond a parody of itself at this point, and the rock that had dominated from the collapse [metacritic.com]

  […] is not usually this severe because of the concomitant contraction metabolic alkalosis. 1 Return to the bedside : The intern stated that although the blood pressure was low and the pulse rate was somewhat elevated, there was no evidence of circulatory collapse [academic.oup.com]

• Gangrene

  短句来源 CONCLUSION The strengthened treatment of insulin pump controls more effectively the all day wave of blood sugar and has quick treatment action on complications of infection, acid poisoning of ketosis, and gangrene of foot. [dict.cnki.net]

• Kussmaul Respiration

  respirations (deep, regular, sighing respirations indicating intense stimulation of the respiratory center) occur See Table 21–12 Blood pH, serum HCO3–, and PCO2 are decreased Anion gap is increased (normochloremic) Hyperkalemia may be seen In lactic [accessmedicine.mhmedical.com]

  Features that might provoke worry include the following: bicarbonate < 7 mEq/L pH < 7 (if measured; there is generally little benefit from measuring pH ) clinically ill-appearing (e.g., dyspnea, marked Kussmaul respirations) These patients generally have [emcrit.org]

  Kussmaul's respiration may be noted where there is deep, slowly rhythmic breathing that increases the minute tidal volume. Children with chronic metabolic acidosis may have growth restriction and show signs of rickets. [patient.info]

  respiration E87.2 Lacticemia, excessive E87.2 Retention - see also Retained carbon dioxide E87.2 ICD-10-CM Codes Adjacent To E87.2 E85.82 Wild-type transthyretin-related (ATTR) amyloidosis E85.9 Amyloidosis, unspecified E86 Volume depletion E86.9 Volume [icd10data.com]

• Tachypnea

  Tachypnea in physiological response to metabolic acidosis can be an early sign. Gastrointestinal side effects are a common side effect with therapeutic metformin use in the absence of lactic acidosis. [calpoison.org]

  The development of lactic acidosis depends on the magnitude of hyperlactatemia, the buffering capacity of the body, and the coexistence of other conditions that produce tachypnea and alkalosis (eg, liver disease, sepsis). [emedicine.medscape.com]

  Signs and symptoms [ edit ] Symptoms and signs of early hypercapnia include flushed skin, full pulse, tachypnea, dyspnea, extrasystoles, muscle twitches, hand flaps ( asterixis ), reduced neural activity, and possibly raised blood pressure. [en.wikipedia.org]

  Tachycardia, tachypnea (with severe lactic acidosis), hypotension with symptoms similar to septic shock. Specific laboratory tests are to help identify the severity and presence of multiorgan involvement. [clinicaladvisor.com]

  Patients experience cardiopulmonary symptoms, including tachycardia, tachypnea and in severe cases, shock. Stage 3 is usually the late stage, occurs 24 hours after the ingestion. [renalandurologynews.com]

• Hyperpnea

  The most characteristic sign is hyperpnea (long, deep breaths at a normal rate), reflecting a compensatory increase in alveolar ventilation; this hyperpnea is not accompanied by a feeling of dyspnea. [merckmanuals.com]

• Sore Throat

  Common Side Effects The most common side effects reported during Actos clinical trials were upper respiratory tract infection, headache, sinus infection, muscle pain and sore throat. [drugwatch.com]

• Vomiting

  Acidosis may not cause any symptoms or it may be associated with nonspecific symptoms such as fatigue, nausea and vomiting. [labtestsonline.org.au]

  They may also vomit as a result of drinking too much. Not eating enough or vomiting can lead to periods of starvation. This further reduces the body’s insulin production. [healthline.com]

  This is the exact opposite of what happens when a person vomits. Vomiting causes metabolic alkalosis because a lot of stomach acid is lost when someone vomits, and this leads to the reduction of acidity within the body. [study.com]

  This is because the symptoms of gastritis – nausea, vomiting and reduced eating – make you think less insulin is needed. And insufficient amounts of insulin can quickly lead to diabetic acidosis. [netdoctor.co.uk]

  More Definitions for acidosis ac·i·do·sis | \ ˌas-ə-ˈdō-səs \ plural acidoses\ -ˌsēz \ Medical Definition of acidosis : an abnormal condition of reduced alkalinity of the blood and tissues that is marked by sickly sweet breath, headache, nausea and vomiting [merriam-webster.com]

• Nausea

  If you develop severe metabolic acidosis, you will likely experience drowsiness and extreme weakness, as well as increased nausea and confusion, Merck Manuals note. [livestrong.com]

  More Definitions for acidosis ac·i·do·sis | \ ˌas-ə-ˈdō-səs \ plural acidoses\ -ˌsēz \ Medical Definition of acidosis : an abnormal condition of reduced alkalinity of the blood and tissues that is marked by sickly sweet breath, headache, nausea and vomiting [merriam-webster.com]

  More severe acidemia (pH 7.10) may cause nausea, vomiting, and malaise. Symptoms may occur at higher pH if acidosis develops rapidly. [merckmanuals.com]

  People with metabolic acidosis often have nausea, vomiting, and fatigue and may breathe faster and deeper than normal. People with respiratory acidosis often have headache and confusion, and breathing may appear shallow, slow, or both. [msdmanuals.com]

• Failure to Thrive

  Failure to thrive, rickets, stunting of growth (seen in children) and osteomalacia or osteopenia (seen in adults) are a result of urinary calcium wastage and a loss of calcium salts from the bones. [orpha.net]

  Congenital chloridorrhea is a genetic disorder which results in a fetus having persistent secretory diarrhea, severe electrolyte disorders, abdominal distension and failure to thrive. [pulmonologyadvisor.com]

• Hypotension

  Incidence of hypotension did not differ between groups (54.5% vs. 61.9%, p = .63). [ncbi.nlm.nih.gov]

  Metabolic acidosis due to paraldehyde overdose is exceedingly rare Iron and isoniazid are just two of many drugs and toxins that cause hypotension and lactic acidosis (isoniazid can also generate a component of ketoacidosis). [emergencymedicinecases.com]

  This resulted in progressive fetal hypoxaemia, acidosis and hypotension. The important question is the threshold of metabolic acidosis beyond which fetal morbidity may occur. [dictionary.cambridge.org]

  In more severe cases it can present with altered mental status, coma, hypotension, hypothermia and respiratory insufficiency. [calpoison.org]

  Some weeks or months (in one case) after starting this therapy they suddenly became critically ill with severe hypotension, renal failure and rapidly deteriorating neurological state. [acutecaretesting.org]

• Tachycardia

  Cardiac telemetry monitoring showed a narrow complex sinus tachycardia. Laboratory analysis of blood collected soon after arrival showed the following blood gas: pH 7.16, pCO2 30 mmHg and bicarbonate of 15. [calpoison.org]

  Precautions Caution in hypertension, cardiovascular disease, congestive heart failure, hyperthyroidism, diabetes, and seizures; not recommended for breastfeeding mothers; adverse reactions include tachycardia, headache, nervousness, dizziness, tremor, [web.archive.org]

  Patients experience cardiopulmonary symptoms, including tachycardia, tachypnea and in severe cases, shock. Stage 3 is usually the late stage, occurs 24 hours after the ingestion. [renalandurologynews.com]

  Extreme acidemia can also lead to neurological and cardiac complications: Neurological: lethargy, stupor, coma, seizures Cardiac: Abnormal heart rhythms (e.g., ventricular tachycardia) and decreased response to epinephrine, both leading to low blood pressure [en.wikipedia.org]

• Confusion

  Acute (or acutely worsening chronic) respiratory acidosis causes headache, confusion, anxiety, drowsiness, and stupor (CO2 narcosis). [msdmanuals.com]

  These include rapid breathing, lethargy, tiredness, headaches and confusion. Diagnosis: Clinical signs and history should allow the underlying identification. [symptoma.com]

  If you develop severe metabolic acidosis, you will likely experience drowsiness and extreme weakness, as well as increased nausea and confusion, Merck Manuals note. [livestrong.com]

  People with respiratory acidosis often have headache and confusion, and breathing may appear shallow, slow, or both. Tests on blood samples typically show pH below the normal range. Doctors treat the cause of the acidosis. [merckmanuals.com]

  Symptoms of respiratory acidosis Symptoms may include fatigue, shortness of breath, and confusion. [healthline.com]

• Lethargy

  These include rapid breathing, lethargy, tiredness, headaches and confusion. Diagnosis: Clinical signs and history should allow the underlying identification. [symptoma.com]

  Confusion or lethargy may also occur. Severe metabolic acidosis can lead to shock or death. [medlineplus.gov]

  Symptoms Return to top Symptoms may include: Confusion Easy fatigue Lethargy Shortness of breath Sleepiness Exams and Tests Return to top A chest x-ray or CT scan is a helpful way of checking the lung's appearance without having to biopsy it. [web.archive.org]

• Stupor

  In respiratory acidosis, the earliest symptoms are Drowsiness may progress to stupor and coma as the oxygen in the blood becomes inadequate. [merckmanuals.com]

  Acute (or acutely worsening chronic) respiratory acidosis causes headache, confusion, anxiety, drowsiness, and stupor (CO2 narcosis). [msdmanuals.com]

  Examination Lethargy, stupor and progression to a state of coma may occur, particularly in cases of poisoning. An intoxicated-appearing patient who has no smell of alcoholic drink on their breath may have ingested ethylene glycol. [patient.info]

• Altered Mental Status

  In more severe cases it can present with altered mental status, coma, hypotension, hypothermia and respiratory insufficiency. [calpoison.org]

  Headache, altered mental status, seizures, coma. Nausea, vomiting, abdominal pain. Chest pain, cardiac dysrhythmias, palpations. [clinicaladvisor.com]

  Symptoms Neurological symptoms associated with this syndrome typically present after the ingestion of enteral formula or food high in carbohydrates (either simple or complex) and include altered mental status, slurred speech, confusion, disorientation [oley.org]

  After 40 days of receiving linezolid therapy, the patient's serum bicarbonate level was normal; however, 1 week later, she experienced nausea, vomiting, abdominal discomfort, and an altered mental status. [academic.oup.com]

  Symptoms may include palpitations, headache, altered mental status such as severe anxiety due to hypoxia, decreased visual acuity, nausea, vomiting, abdominal pain, altered appetite and weight gain, muscle weakness, bone pain, and joint pain. [en.wikipedia.org]

• Cognitive Impairment

  Some symptoms of alkalosis include cognitive impairment (which can progress to unconsciousness), tingling or numbness in the extremities, muscle twitching and spasm, and nausea and vomiting. [courses.lumenlearning.com]

A full history and a thorough clinical examination will allow a correct diagnosis.

Laboratory support will provide extra information with arterial blood gas analyses and electrolyte analysis with a basic metabolic panel. These will confirm the acidosis and identify whether it is metabolic or respiratory in origins [8].

• Ketonuria

  […] ketoacidosis Alcoholic ketoacidosis Acid-base disorders in alcoholism are frequently mixed (10% have triple acid-base disorder) Three types of metabolic acidoses: ketoacidosis, lactic acidosis, and hyperchloremic acidosis from bicarbonate loss in urine from ketonuria [accessmedicine.mhmedical.com]

  Caution if ketonuria or drug anions are in the urine as it would invalidate the calculation. Diarrhea : UAG is a negative value. Renal tubular acidosis : UAG is positive value. As an aid, UAG is neGUTive when associated with bowel causes. [pulmonologyadvisor.com]

  (i) The importance of ketonuria in prolonged fasting The medical resident began with the following statement. ‘ If the kidneys were to reabsorb 100% of filtered ketoacid anions, perhaps this would be a better adaptation in prolonged starvation, because [academic.oup.com]

• Hypercapnia

  Hypercapnia and respiratory acidosis ensue when impairment in ventilation occurs and the removal of carbon dioxide by the respiratory system is less than the production of carbon dioxide in the tissues. [emedicine.com]

  It is completed within 5-10 min from onset of hypercapnia. b. [slideshare.net]

  Oxygen therapy should be used with caution because it may worsen hypercapnia in some situations. [web.archive.org]

  Acidosis was more frequent in the midazolam group (63.6% vs. 28.6%, p = .03), as was hypercapnia (50% vs. 14.3%, p = .03) while occurrence of hypoxemia did not differ between groups (22.7 vs. 33.3%, p = .5). [ncbi.nlm.nih.gov]

  Alveolar hypoventilation leads to an increased PaCO 2 (ie, hypercapnia). The increase in PaCO 2, in turn, decreases the bicarbonate (HCO 3 – )/PaCO 2 ratio, thereby decreasing the pH. [emedicine.medscape.com]

• Hypocapnia

  It is completed within 5-10 min from onset of hypocapnia b. [slideshare.net]

  Often these diseases stimulate ventilation and hypocapnia due to reflex receptors and hypoxia. Hypercapnia typically occurs late in the disease process with severe pulmonary disease or when respiratory muscles fatigue. [emedicine.com]

  Mineralocorticoid Deficiency Angiotensin Deficiency: Liver Failure ACE Inhibitor Renin Deficiency Aging Extracellular fluid volume expansion Lead Beta Blocker s Prostaglandin Inhibitor Methyldopa Carbonic anhydrase inhibitor Acetazolamide Mefenamic acid Post-hypocapnia [fpnotebook.com]

• Lactate Decreased

  Likewise, no lactate decrease or a decrease of less than 20% in the first 2- to 4-h is associated with a worse prognosis in trauma patients [77]. Initial hyperlactatemia is also associated with a greater treatment burden. [annalsofintensivecare.springeropen.com]

• Bicarbonate Increased

  If the primary disorder is acute respiratory acidosis, bicarbonate increases by 1 unit above 24 mEq/L for every 10 units of increase in pCO2 above a baseline of 40 mm Hg; If the primary disorder is acute respiratory alkalosis, bicarbonate decreases by [amboss.com]

The mainstay of treatment is the use of appropriate fluid therapy using either oral or intravenous routes.

Sodium acetate may be used specifically to neutralise the acids.

At the same time the underlying cause must be treated.

In the most severe cases, severe measures such as mechanical ventilation or liver transplantation may be indicated [9].

The prognosis is generally favourable if prompt treatment is initiated. However, complications depend on the underlying cause.

Acidosis occurs when the pH (hydrogen ion concentration) of blood plasma falls below 7.35.

1. Respiratory acidosis (also known as hypercapnic acidosis) is the result of too much carbon dioxide remaining in the body because inadequate amounts are being removed by breathing.
2. Metabolic acidosis occurs when either too much acid is produced in the body or too little is removed by the kidneys [2].

1. Respiratory acidosis can be caused by inadequate respiratory function for several underlying reasons -

• Chest injuries,
• Chest deformities e.g. kyphosis,
• Weakness of chest muscles,obesity
• Chronic lung disease, e.g. asthma,
• Nervous system abnormalities,
• Overuse of sedative medication.

2. Several different forms of metabolic acidosis can occur with several various types of underlying pathology:

Lactic acidosis occurs as a result of the build-up of lactic acid -

• prolonged exercise,
• cancer,
• drinking excess alcohol,
• liver failure,
• hypoglycaemia,
• medications, e.g. salicylates, ethylene glycol (antifreeze) or methanol;
• MELAS syndrome (Mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes) which is a rare mitochondrial disorder 
• Prolonged lack of oxygen as a result of heart failure, shock or severe anaemia 

Diabetic acidosis (also known as diabetic ketoacidosis – DKA) occurs as a result of the accumulation of acidic ketone bodies during uncontrolled diabetes mellitus.

Hyperchloraemic acidosis occurs with the loss of sodium bicarbonate from the body, e.g. sever diarrhoea or vomiting.

Other reasons for metabolic acidosis include – [3]

• Kidney disease – with proximal or distal renal tubular acidosis
• Severe dehydration
• A high-fat plus low-carbohydrate diet

Metabolic acidosis can either be caused when there is inadequate removal of excessive metabolicacids by the kidneys or over-production of metabolic acids elsewhere in body by other disturbed systems. These latter include urea and creatinine as well as the metabolic residues of protein catabolism. Overproduction of lactic acid can occur with excessive exercise or as a result of hypoxia in tissues with poor blood perfusion or low blood oxygen levels [4].
Stimulation of chemoreceptors by the raised acid levels leads to increased alveolar ventilation and results in some compensation for metabolic acidosis by the lungs with increased carbon dioxide exhalation. This alters the body’s buffering system to further reduce the metabolic acidosis.

Respiratory acidosis is usually the result of ineffective breathing and to return this back to a normal condition it will usually be useful to reverse the acidosis. However, where there is severe disturbance, e.g. trauma or nerve paralyses, mechanical ventilation may be needed as well [5].

Mechanisms for prevention depend on the underlying cause. Metabolic acidosis can be prevented by ensuring the proper management of the underlying causes, e.g hepatic, renal and diabetic disease as well as avoiding excessive exercise or dehydration [10].

Normally the kidneys and the lungs maintain the balance between acids and bases in the body as part of homoeostasis so that the level of acidity (pH) is maintained within a narrow range – about 7.4. When either the acids build up or the bicarbonate (base) is lost, acidosis develops [1].

Definition: Acidosis is a buildup of acids in the body so that the pH of the blood plasma falls below 7.35

Cause: There are two types of acidosis depending on the underlying cause.

1. Metabolic acidosis - in which the kidneys are unable to effectively remove the acids produced by the body’s metabolism or in which the body is over-producing certain acids so that normal mechanisms can no longer maintain the level of hydrogen ions within the normal range. Potential causes include uncontrolled diabetes, over-exercise, poor diet, dehydration, overuse of drugs, diseases of the kidney and liver.

2. Respiratory acidosis results from the inability of the lungs to effectively remove carbon dioxide from the body. Changes in the lung ventilation may be caused by such chronic diseases as asthma, chest deformities, cancer, trauma to the chest or altered nerve function.

Symptoms: The symptoms of acidosis are similar for both the respiratory and metabolic forms. These include rapid breathing, lethargy, tiredness, headaches and confusion.

Diagnosis: Clinical signs and history should allow the underlying identification. Analysis of blood samples supported by a basic metabolic panel will provide an electrolyte analysis, while arterial blood gas analysis will conform the acidosis and identify whether this is metabolic or respiratory in origins.

Treatment: Fluid therapy with appropriate solutions, either oral or intravenous, will be used to correct the acidosis. Sometimes sodium acetate is used separately to neutralize the acids. Correcting the underlying problem is also important. Sometime mechanical ventilation is needed to correct severe respiratory acidosis.

Prevention: Correct management of the disease is critical to prevention its further development. Examples include controlling diabetes and avoiding excessive exercise or severe weather that might lead to dehydration.

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