Acidosis Diagnosis and Treatment

Introduction to Acidosis

Acidosis is defined as a blood pH below 7.35 and can be classified into two main types: respiratory and metabolic, with targeted treatment based on severity, underlying cause, and pH level 1
The American Thoracic Society defines respiratory acidosis as caused by increased arterial partial pressure of carbon dioxide (CO₂) and results from alveolar hypoventilation, which can be acute or chronic 1

Metabolic acidosis is caused by increased acid production, decreased acid excretion, or bicarbonate loss, and can be further classified based on anion gap, according to the Thorax journal 1
Symptoms of acidosis include confusion, altered mental status, fatigue, shortness of breath, headache, nausea, and vomiting, with specific symptoms varying by type (respiratory or metabolic) 1
The Infectious Diseases Society of America notes that metabolic acidosis can lead to abdominal pain, shock-like state in severe cases, cardiac arrhythmias, decreased cardiac contractility, and insulin resistance 2

Blood gas analysis is used to diagnose acidosis, with arterial pH < 7.35 indicating acidosis, PaCO₂ > 45 mmHg suggesting respiratory component, and bicarbonate < 22 mEq/L suggesting metabolic component, as recommended by the Thorax journal 1
Calculation of anion gap is also important, with normal values ranging from 8-12 mEq/L, and elevated values indicating metabolic acidosis due to ketoacidosis, lactic acidosis, renal failure, or toxins 1

The primary treatment goal for all types of acidosis is to address the underlying cause, according to the Praxis Medical Insights guideline 5
Supportive care includes ensuring adequate oxygenation, maintaining tissue perfusion, and correcting fluid deficits, as recommended by the Praxis Medical Insights guideline 5
For severe metabolic acidosis (pH < 7.2), sodium bicarbonate therapy may be considered, with dosing and monitoring as needed, according to the Praxis Medical Insights guideline 5
Specific conditions such as diabetic ketoacidosis, lactic acidosis, and renal failure require targeted treatment, including insulin therapy, fluid resuscitation, and dialysis if indicated, as recommended by the Praxis Medical Insights guideline 5

D-Lactic acidosis in short bowel syndrome requires restriction of mono and oligosaccharides, encouragement of slowly digestible polysaccharides, thiamine supplements, and broad-spectrum antibiotics, as recommended by the Gut journal 4
Hyperammonaemic acidosis may occur in short bowel patients and requires consideration of arginine supplementation, according to the Gut journal 4
Chronic respiratory acidosis requires compensatory increase in bicarbonate and treatment focuses on underlying cause rather than bicarbonate administration, as noted by the Thorax journal 1

Serial arterial blood gases, electrolytes, clinical symptoms, hemodynamic parameters, and cardiac rhythm are important for monitoring acidosis treatment, according to the Praxis Medical Insights guideline 5