An acid-base balance disorder is a condition when the levels of acid and base in the blood are out of balance. This condition can interfere with the work of various organs.
Acid-base (pH) levels in the blood are measured on a pH scale, from 1-14. Normal blood pH levels range from 7.35 to 7.45. A person's blood is considered too acidic if the pH is less than 7.35. This condition is called acidosis. Meanwhile, blood with a pH value greater than 7.45 is categorized as too alkaline, or is called alkalosis.
Types of acid-base balance disorders
Acid-base balance is affected by lung function. Humans breathe in oxygen and expel it in the form of carbon dioxide (CO2). CO2 is an acidic substance, so the amount of CO2 that comes out will affect the pH balance of the blood, so that it can cause acidosis or alkalosis. Acidosis and alkalosis caused by disorders of the lungs or breathing are known as respiratory acidosis and respiratory alkalosis.
Acidosis and alkalosis can also occur when the production of acid-base in the body is not balanced or it can also occur due to the kidneys not being able to remove excess acid or base from the body. Acidosis and alkalosis that occurs as a result of the two conditions above are called metabolic acidosis and metabolic alkalosis.
Symptoms of Acid Base Balance Disorders
Symptoms of acid-base balance disorders depend on the type of disorder experienced. Below will be explained in more detail about the symptoms of each of these disorders.
respiratory acidosis
Respiratory acidosis can occur suddenly (acute) or long-term (chronic). Generally, chronic respiratory acidosis does not cause any symptoms. However, in some cases, sufferers may experience memory loss, sleep disturbances, and personality changes.
Whereas in acute respiratory acidosis, the initial symptoms are headache, anxiety, restlessness, confusion, and blurred vision. If not treated immediately, other symptoms can appear such as weakness, shortness of breath, decreased consciousness, to coma.
Metabolic acidosis
Symptoms of metabolic acidosis are quite diverse. Some sufferers of this condition generally have fruit-scented breath. These symptoms are signs of diabetic ketoacidosis or metabolic acidosis that occurs in diabetic patients. Diabetic ketoacidosis is a dangerous condition, which can interfere with liver and kidney function.
Other symptoms of metabolic acidosis include:
- Dizzy
- Headache
- Decreased appetite
- Easily sleepy
- Tired easily
- Breath fast and deep
- Heart rate increases
respiratory alkalosis
A common symptom of respiratory alkalosis is breathing too fast or too deeply. This condition is known as hyperventilation. Other symptoms that can occur due to low levels of carbon dioxide in the blood include:
- Dizzy
- bloating
- dry mouth
- Muscle cramps in hands and feet
- tingling
- Chest pain
- Hard to breathe
- Heart rhythm disturbances
Metabolic alkalosis
Patients with metabolic alkalosis generally experience hypoventilation, which is a condition when the patient breathes too slowly or too shallowly. This condition causes oxygen levels in the blood to be too low. On the other hand, the level of carbon dioxide in the body increases.
Hypokalemia, or low levels of potassium in the blood, also often accompanies metabolic alkalosis. Therefore, patients may experience symptoms such as easy fatigue, muscle aches, frequent urination (polyuria), and heart rhythm disturbances (arrhythmias).
Other symptoms in people with metabolic alkalosis include blue skin or nails, shortness of breath, muscle cramps and spasms, and irritability.
Causes of Acid Base Balance Disorders
Each type of acid-base balance disorder, caused by different conditions. Respiratory acidosis and respiratory alkalosis are caused by disorders of the lungs. Meanwhile, metabolic acidosis and metabolic alkalosis are triggered by problems with the kidneys.
Below will be explained the causes of each type of acid-base balance disorders.
respiratory acidosis
Respiratory acidosis is caused by lung disease or other conditions that affect the function of the lungs to remove carbon dioxide (CO2). In other words, respiratory acidosis occurs when the body can get rid of only a small amount of CO2. A number of conditions can trigger chronic respiratory acidosis, including:
- Asthma.
- Chronic obstructive pulmonary disease.
- Pulmonary edema.
- Disorders of the nervous system and muscles, for example multiple sclerosis and muscular dystrophy.
- Other conditions that make a person disturbed in breathing, such as obesity or scoliosis.
While acute respiratory acidosis is generally caused by several conditions, such as:
- Cardiac arrest.
- Lung diseases, such as asthma, pneumonia, and emphysema.
- Respiratory muscle weakness.
- There is a blockage in the respiratory tract.
- Sedative overdose.
Metabolic acidosis
Metabolic acidosis occurs when the body produces too much acid, or when the kidneys are only able to excrete a small amount of acid in the urine. Metabolic acidosis is divided into several types, namely:
- Diabetic acidosis. Diabetic acidosis or diabetic ketoacidosis occurs when the body lacks insulin, so fat is broken down instead of carbohydrates. The breakdown of these fats results in an increase in acidic blood ketones. This condition is more common in patients with uncontrolled type 1 diabetes.
- Hyperchloremic acidosis. Hyperchloremic acidosis is caused by a lack of sodium bicarbonate in the body. This condition can be caused by diarrhea
- Lactic acidosis. This condition occurs when the body has too much lactic acid. Lactic acidosis can be caused by alcohol consumption (alcoholic ketoacidosis), cancer, heart failure, seizures, liver failure, low blood sugar levels, and lack of oxygen and excessive exercise.
In addition to the above conditions, metabolic acidosis can also be caused by kidney disease, severe dehydration, and aspirin poisoning.
respiratory alkalosis
Respiratory alkalosis is generally caused by hyperventilation, which is a condition when a person breathes too fast or too deeply. Hyperventilation can be caused by feelings of panic and anxiety. Other conditions that can trigger respiratory alkalosis are:
- High fever
- Being in the highlands
- Lung disease
- liver disease
- Lack of oxygen
- Salicylate poisoning
Metabolic alkalosis
Metabolic alkalosis occurs when a person's body lacks acid or excess base. Some things that can trigger this condition are:
- Prolonged vomiting, causing the body to lack electrolytes.
- Excessive use of diuretic drugs.
- Adrenal gland disease.
- Use of laxatives and ulcer drugs (antacids).
Diagnosis of Acid-Base Balance Disorder
There are several examination methods to diagnose acid-base balance disorders, including:
Blood gas analysis
This examination is done by taking a sample of the patient's blood through an artery in the wrist, arm, or groin. Blood gas analyzes measure a number of elements that affect acid-base balance, including:
- blood pH
The level of acid-base balance is considered normal when the blood pH is in the range of 7.35 to 7.45. A pH level that is less than 7.35 is considered too acidic.
- Bicarbonate
Bicarbonate is a chemical that functions to balance acid and base levels. Normal bicarbonate levels range from 22-28 mEq/L.
- Oxygen saturation
Oxygen saturation is a measure of the level of oxygen carried by hemoglobin in red blood cells. Normal oxygen saturation (SaO2) values range from 94-100 percent.
- Oxygen partial pressure
The partial pressure of oxygen (PaO2) is a measure of the pressure of oxygen dissolved in the blood. This measure determines how well oxygen flows from the lungs to the blood. Normal PaO2 is in the range of 75-100 mmHg.
- Partial pressure of carbon dioxide
The partial pressure of carbon dioxide (PaCO2) is a measure of the pressure of CO2 dissolved in the blood. This measure determines how well CO2 gets out of the body. The normal value of PaCO2 is in the range of 38-42 mmHg.
Metabolic blood test
A blood test to see metabolic abnormalities is done by taking a sample of the patient's blood through a vein in the hand or arm. Besides being used to measure blood pH levels, this test also measures a number of chemical elements in the blood such as blood sugar, protein, calcium, and electrolytes.
Lung examination
In patients suspected of having respiratory acidosis, the doctor will run a chest X-ray to see the condition of the lungs. In addition to chest X-rays, doctors can run lung function tests such as spirometry and plethysmography. Spirometry is an examination to measure the amount of air inhaled and exhaled. Whereas plethysmography aims to measure the volume of air in the lungs.
Apart from examining blood samples, acid-base balance disorders can be diagnosed through a urine test (urinalysis). Through urinalysis, it can be a sign of changes in acid-base levels in patients.
Treatment of Acid Base Balance Disorders
Treatment of acid-base balance disorders depends on the type of disorder experienced.
respiratory acidosis
One of the methods of treatment for respiratory acidosis is with drugs, which include:
- Antibiotics, to treat infections.
- Bronchodilators, to widen the airways.
- Diuretics, to reduce excess fluid in the heart and lungs.
- Corticosteroids, to reduce inflammation.
Respiratory acidosis can also be treated by a method called continuous positive airway pressure (CPAP). In this therapy, the patient will be asked to wear a mask over the nose and/or mouth. Then, the machine connected to the mask, will flow positive pressure air into the respiratory tract.
Metabolic acidosis
Treatment of metabolic acidosis depends on the underlying cause, including:
- Sodium bicarbonate infusion in hyperchloremic acidosis.
- Injection of insulin in patients with diabetic acidosis.
- Giving replacement body fluids by injection.
- Detoxification in acidosis experiencing drug or alcohol poisoning.
In patients with lactic acidosis, doctors can give bicarbonate supplements or injections to replace body fluids. Oxygen or antibiotics may also be given, depending on the underlying cause.
respiratory alkalosis
In respiratory alkalosis caused by hyperventilation, the doctor may advise the patient to inhale carbon dioxide. First, exhale into the paper bag. Then, inhale the carbon dioxide in the bag earlier. Repeat this step several times. This method can help increase the level of carbon dioxide in the blood.
Please note that the above method should only be used if the doctor has confirmed that hyperventilation is due to an acid-base balance disorder. If you are experiencing these symptoms for the first time, it is highly recommended to seek medical attention immediately to the hospital.
Metabolic alkalosis
Treatment of metabolic alkalosis depends on the underlying cause. In some cases, the doctor may prescribe the following types of drugs:
- Carbonic anhydrase inhibitor diuretics, such as acetazolamide.
- Potassium-sparing diuretics such as spironolactone.
- ACE inhibitors, such as captopril and lisinopril.
- Corticosteroids, such as dexamethasone.
- Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen.
Complications of Acid Base Balance Disorders
Untreated acidosis can lead to a number of complications. Among others are:
- Kidney stones
- Kidney failure
- bone disease
- The process of growth and development is hampered
- Respiratory system failure
- Shock
Like acidosis, untreated alkalosis can lead to a number of complications, including:
- Heart rhythm disturbances (arrhythmias)
- Electrolyte disturbances, especially hypokalemia
- Coma
Prevention of Acid Base Balance Disorders
Acidosis cannot be completely prevented. However, there are steps you can take to reduce the risk. Prevention depends on the type of acidosis experienced, as will be explained below.
Prevention of respiratory acidosis:
- Quit smoking to prevent lung damage.
- Maintain an ideal body weight, because obesity (excess weight) can make it difficult for you to breathe.
Prevention of metabolic acidosis: Alkalosis can be prevented by keeping the body hydrated, and following a healthy diet. Choosing nutritious, high-potassium foods can help prevent electrolyte deficiencies. Examples of foods high in potassium are spinach, beans, bananas, and carrots. Meanwhile, to prevent dehydration, it is recommended to do the following: Especially for respiratory alkalosis, prevention can be done by treating the causes of hyperventilation, such as stress and panic. Among them with meditation, breathing exercises, or regular exercise.