Acidosis

Introduction
Acidosis is a clinical disturbance characterized by an excess of acid in the body fluids, leading to a decrease in blood pH below the normal range (7.35–7.45). It is broadly classified into metabolic acidosis and respiratory acidosis, each with distinct causes, pathophysiology, and therapeutic strategies. The treatment approach is guided by identifying the underlying cause, correcting biochemical derangements, and preventing complications such as arrhythmias, impaired organ function, and hemodynamic instability.

1. Metabolic Acidosis

• Underlying cause correction:

  • Diabetic ketoacidosis (DKA): IV insulin infusion, isotonic fluids, and potassium supplementation.

  • Lactic acidosis: Improve tissue perfusion with oxygen therapy, IV fluids, and vasopressors if needed.

  • Renal tubular acidosis or advanced kidney disease: Sodium bicarbonate supplementation, dialysis in severe cases.

  • Toxin ingestion (methanol, ethylene glycol, salicylates): Antidotes (fomepizole, ethanol for methanol/ethylene glycol), bicarbonate therapy, and hemodialysis.

• Alkali therapy:

  • Sodium bicarbonate: Administered IV in severe acidosis (pH < 7.1), with close monitoring to avoid volume overload and hypokalemia.

• Dialysis:

  • Indicated in severe or refractory metabolic acidosis, particularly with renal failure or toxin ingestion.

2. Respiratory Acidosis

• Improve ventilation:

  • Treat underlying causes such as chronic obstructive pulmonary disease (COPD), asthma exacerbations, or neuromuscular weakness.

  • Non-invasive ventilation (e.g., BiPAP) for acute exacerbations.

  • Intubation and mechanical ventilation for severe cases with respiratory failure.

• Bronchodilators and steroids:

  • Used in obstructive airway conditions to relieve bronchospasm and reduce airway inflammation.

• Antibiotics:

  • Prescribed if respiratory acidosis is secondary to pneumonia or other respiratory infections.

3. Supportive and Symptomatic Management

• Electrolyte balance: Correct potassium, calcium, and phosphate disturbances.

• Oxygen therapy: Carefully administered, especially in patients with chronic CO₂ retention (e.g., COPD).

• Hemodynamic support: IV fluids, vasopressors for septic or hypovolemic shock.

4. Lifestyle and Preventive Measures

• Adequate control of diabetes to prevent DKA.

• Avoidance of excessive alcohol and toxins associated with metabolic acidosis.

• Smoking cessation and adherence to pulmonary rehabilitation programs for patients with chronic lung disease.

• Routine monitoring of renal function in patients with chronic kidney disease.

5. Multidisciplinary Care

• Involvement of critical care, nephrology, pulmonology, and emergency medicine specialists.

• Nutritional and metabolic counseling in patients with chronic conditions predisposing to recurrent acidosis.