What is Acidosis? The Truth About a 'pH Deficiency'
While the term 'pH deficiency' is not a standard medical diagnosis, it colloquially refers to acidosis, a serious medical condition where there is too much acid in the body fluids. This occurs when the body either produces too much acid, loses too much base (bicarbonate), or fails to remove enough acid through the lungs or kidneys. A normal blood pH is tightly regulated between 7.35 and 7.45; any reading below this range is considered acidemia and indicates acidosis. A variety of underlying conditions can disrupt this balance, with symptoms ranging from mild to life-threatening.
Common symptoms of metabolic and respiratory acidosis
The symptoms experienced from acidosis depend on its underlying cause and whether it is metabolic or respiratory in nature. In mild or early cases, an individual might not notice any symptoms at all. However, as the condition worsens, signs become more pronounced.
Symptoms of metabolic acidosis
- Respiratory Changes: Fast, deep, or labored breathing (known as Kussmaul respirations) as the body attempts to compensate by expelling more carbon dioxide.
- Neurological: Headache, confusion, fatigue, and lethargy. Severe cases can lead to stupor, coma, or seizures.
- Gastrointestinal: Nausea, vomiting, and loss of appetite.
- Cardiovascular: An accelerated heart rate. In extreme acidemia, cardiac function can be impaired, leading to dangerously low blood pressure.
- Other: Weakness and an unusually fruity or sweet smell on the breath (a sign of diabetic ketoacidosis).
Symptoms of respiratory acidosis
- Breathing Difficulties: Shallow or slow breathing, or shortness of breath.
- Neurological: Headache, confusion, anxiety, and lethargy. This can progress to a stupor and coma in severe cases due to inadequate oxygen.
- General Malaise: Being easily fatigued, with warm and flushed skin and sweating.
The causes behind acid buildup
Acidosis is not a disease itself but rather a sign of an underlying medical issue. Causes are categorized based on whether the problem originates from the metabolic system (kidneys and body chemistry) or the respiratory system (lungs and breathing).
Causes of metabolic acidosis
- Diabetic Ketoacidosis (DKA): In uncontrolled diabetes, especially type 1, the body produces high levels of acidic ketone bodies for energy when insulin is insufficient.
- Lactic Acidosis: A buildup of lactic acid, often resulting from insufficient oxygen reaching tissues during shock, heart failure, or intense exercise. It can also be caused by severe infections (sepsis) or liver failure.
- Kidney Disease: Impaired kidney function prevents the body from effectively filtering and removing excess acids from the blood. This is a common cause, particularly in later stages of chronic kidney disease.
- Severe Diarrhea: A large loss of bicarbonate (a base) from the body can occur with severe diarrhea, causing the body's pH to drop.
- Poisoning: Ingesting toxic substances like aspirin, methanol, or ethylene glycol (antifreeze) can lead to an accumulation of acids.
Causes of respiratory acidosis
- Chronic Lung Disease: Conditions such as severe asthma and chronic obstructive pulmonary disease (COPD) can impair lung function, leading to the retention of carbon dioxide.
- Chest Trauma or Muscle Weakness: Injuries to the chest or neuromuscular disorders like muscular dystrophy can prevent proper chest expansion and effective breathing.
- Overuse of Sedatives: Certain drugs can depress the central nervous system, slowing down breathing and causing carbon dioxide buildup.
Diagnosis and treatment
Diagnosing acidosis involves a comprehensive assessment that includes reviewing symptoms and running specific laboratory tests. Treatment is highly dependent on addressing the underlying cause.
- Diagnosis: Doctors typically use blood tests, such as an arterial blood gas (ABG) test, to measure blood pH, carbon dioxide levels (pCO2), and bicarbonate (HCO3-). An anion gap calculation can help determine the specific cause of metabolic acidosis. Urine tests can also check for ketones or measure pH.
- Treatment: For metabolic acidosis, treatment might involve administering sodium bicarbonate, managing diabetes with insulin, or providing IV fluids. In respiratory acidosis, treatment focuses on improving lung function, which can include using bronchodilators, antidotes for overdose, or even mechanical ventilation for severe cases.
Long-term complications
If not properly managed, both acute and chronic acidosis can lead to severe and potentially life-threatening complications.
- Kidney Damage: Chronic metabolic acidosis can worsen pre-existing kidney disease and, if left untreated, accelerate the progression to kidney failure.
- Bone Health: The body's buffering system can draw minerals from bones to neutralize excess acid, leading to a loss of bone density and increasing the risk of conditions like osteoporosis and fractures.
- Muscle Wasting: Protein degradation can increase with chronically high acid levels, resulting in significant muscle loss over time.
- Cardiovascular Issues: Severe acidemia can impair heart function, leading to abnormal heart rhythms (arrhythmias) and low blood pressure.
- Growth Issues: Chronic metabolic acidosis can hinder growth in children.
Metabolic vs. Respiratory Acidosis: Key Differences
| Feature | Metabolic Acidosis | Respiratory Acidosis |
|---|---|---|
| Underlying Cause | The kidneys cannot adequately filter or excrete acid, or the body loses too much base or produces too much acid. | The lungs cannot effectively remove carbon dioxide through breathing, causing it to build up in the blood. |
| Primary System Affected | Digestive and urinary systems. | Respiratory system (lungs). |
| Key Blood Gas Change | Low bicarbonate levels (HCO3-). | High carbon dioxide levels (pCO2). |
| Compensatory Mechanism | The lungs increase breathing rate to exhale more carbon dioxide. | The kidneys increase bicarbonate retention to neutralize excess acid. |
| Common Symptoms | Deep, rapid breathing, fatigue, confusion, nausea. | Shallow or slow breathing, headache, confusion, sleepiness. |
Conclusion
While the term 'pH deficiency' is not medically standard, the condition it describes—acidosis—is a serious health concern resulting from an imbalanced acid-base level in the blood. Whether caused by metabolic issues affecting the kidneys or respiratory problems hindering the lungs, acidosis requires prompt medical attention to identify and treat the underlying cause. The wide range of symptoms, from fatigue and nausea to serious cardiac and neurological complications, underscores the importance of a proper diagnosis through blood and urine testing. Addressing acidosis effectively can prevent severe, long-term complications affecting the bones, muscles, and major organs. If you experience symptoms, it is essential to consult a healthcare professional for an accurate diagnosis and treatment plan.
For more information on the diagnosis and treatment of acidosis, you can visit the Cleveland Clinic website: https://my.clevelandclinic.org/health/diseases/24492-metabolic-acidosis.
