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Describe How The Kidneys Respond To Respiratory Acidosis

Blood Gas Analysis--insight Into The Acid-base Status Of The Patient

Blood Gas Analysis--insight Into The Acid-base Status Of The Patient

Acid-Base Physiology Buffers H+ A- HCO3- CO2 Buffers H+ A- CO2 Cells Blood Kidney Lungs Fluids, Electrolytes, and Acid-Base Status in Critical Illness Blood Gas Analysis--Insight into the Acid-Base status of the Patient The blood gas consists of pH-negative log of the Hydrogen ion concentration: -log[H+]. (also, pH=pK+log [HCO3]/ 0.03 x pCO2). The pH is always a product of two components, respiratory and metabolic, and the metabolic component is judged, calculated, or computed by allowing for the effect of the pCO2, ie, any change in the pH unexplained by the pCO2 indicates a metabolic abnormality. CO +H 0ºº H CO ººHCO + H2 2 2 3 3 - + CO2 and water form carbonic acid or H2CO3, which is in equilibrium with bicarbonate (HCO3-)and hydrogen ions (H+). A change in the concentration of the reactants on either side of the equation affects the subsequent direction of the reaction. For example, an increase in CO2 will result in increased carbonic acid formation (H2CO3) which leads to an increase in both HCO3- and H+ (\pH). Normally, at pH 7.4, a ratio of one part carbonic acid to twenty parts bicarbonate is present in the extracellular fluid [HCO3-/H2CO3]=20. A change in the ratio will affect the pH of the fluid. If both components change (ie, with chronic compensation), the pH may be normal, but the other components will not. pCO -partial pressure of carbon dioxide. Hypoventilation or hyperventilation (ie, minute2 ventilation--tidal volume x respitatory rate--imperfectly matched to physiologic demands) will lead to elevation or depression, respectively, in the pCO2. V/Q (ventilation/perfusion) mismatch does not usually lead to abnormalities in PCO2 because of the linear nature of the CO2 elimination curve (ie, good lung units can make up for bad lung units). Diffus Continue reading >>

Regulation Of Acid-base Balance

Regulation Of Acid-base Balance

There is precise regulation or maintenance of ‘free H+ ions’ in body fluids. Balance is Achieved by Three Defense Mechanisms:- • First defense: Chemical buffering • 2nd defense: Respiratory (alteration in arterial CO2) • 3rd defense: Renal (alteration in HCO-3 excretion) Acid Base Regulation/Balance 1. Chemical Buffer system: – Responds within seconds – Does not eliminate or add H+ from body – Operates by binding or to tied up H+ till balance is reestablished. a. In ECF: – Mainly HCO-3/CO2 Buffer system – Plasma Proteins – HPO–4/H2PO-4 Buffer system b. In ICF: – Proteins Mainly e.g.: Hb in RBCs – HPO–4/H2PO-4 Buffer system Routes of excretion of acids; lungs & kidneys 2. Respiratory Mechanisms: – Responds within minutes – Takes 6-12 hours to be fully effective – Operates by excreting CO2 or (adding H2CO3/HCO-3) 3. Renal Mechanisms: • Responds slowly (effectively in 3-5 days) • Eliminates excess Acids or Base from body • The most powerful mechanism e.g. i. HCO-3/CO2 Buffer system ii. NH3/NH+4 Buffer system iii. HPO–4/H2PO-4 Buffer system Chemical Buffer System • Consists of a ‘pair of substances’ present in a mixture of a solution that ‘minimizes pH changes’ when an ‘acid or base’ is ‘added or removed’ from the solution. • Consists of; 1. Carbonic Acid – Bicarbonate Buffer System 2. Phosphate Buffer system 3. Protein Buffer system Chemical Buffer System of ECF 1. Bicarbonate Buffer System: H2CO3/NaHCO3 consists of H2CO3 (weak Acid) + NaHCO3 (Bicarbonate salt) – CO2 + H2O ↔H2CO3 ↔ H+ + HCO-3 – NaHCO3 ↔ Na+ + HCO-3 → H2CO3 → CO2 + H2O Bicarbonate buffer system is quantitatively the most powerful ECF buffer system Its two components HCO-3 & CO2 are precisely regulated by kidneys & lungs. 2. Phos Continue reading >>

Merck And The Merck Manuals

Merck And The Merck Manuals

Acidosis is caused by an overproduction of acid in the blood or an excessive loss of bicarbonate from the blood (metabolic acidosis) or by a buildup of carbon dioxide in the blood that results from poor lung function or depressed breathing (respiratory acidosis). If an increase in acid overwhelms the body's acid-base control systems, the blood will become acidic. As blood pH drops (becomes more acidic), the parts of the brain that regulate breathing are stimulated to produce faster and deeper breathing (respiratory compensation). Breathing faster and deeper increases the amount of carbon dioxide exhaled. The kidneys also try to compensate by excreting more acid in the urine. However, both mechanisms can be overwhelmed if the body continues to produce too much acid, leading to severe acidosis and eventually heart problems and coma. The acidity or alkalinity of any solution, including blood, is indicated on the pH scale. Metabolic acidosis develops when the amount of acid in the body is increased through ingestion of a substance that is, or can be broken down (metabolized) to, an acid—such as wood alcohol (methanol), antifreeze (ethylene glycol), or large doses of aspirin (acetylsalicylic acid). Metabolic acidosis can also occur as a result of abnormal metabolism. The body produces excess acid in the advanced stages of shock and in poorly controlled type 1 diabetes mellitus (diabetic ketoacidosis). Even the production of normal amounts of acid may lead to acidosis when the kidneys are not functioning normally and are therefore not able to excrete sufficient amounts of acid in the urine. Major Causes of Metabolic Acidosis Diabetic ketoacidosis (buildup of ketoacids) Drugs and substances such as acetazolamide, alcohols, and aspirin Lactic acidosis (buildup of lactic acid Continue reading >>

Acid-base Balance

Acid-base Balance

pH, Buffers, Acids, and Bases Acids dissociate into H+ and lower pH, while bases dissociate into OH− and raise pH; buffers can absorb these excess ions to maintain pH. Learning Objectives Explain the composition of buffer solutions and how they maintain a steady pH Key Takeaways A basic solution will have a pH above 7.0, while an acidic solution will have a pH below 7.0. Buffers are solutions that contain a weak acid and its a conjugate base; as such, they can absorb excess H+ ions or OH– ions, thereby maintaining an overall steady pH in the solution. pH is equal to the negative logarithm of the concentration of H+ ions in solution: pH = −log[H+]. Key Terms alkaline: having a pH greater than 7; basic acidic: having a pH less than 7 buffer: a solution composed of a weak acid and its conjugate base that can be used to stabilize the pH of a solution Self-Ionization of Water Hydrogen ions are spontaneously generated in pure water by the dissociation (ionization) of a small percentage of water molecules into equal numbers of hydrogen (H+) ions and hydroxide (OH−) ions. The hydroxide ions remain in solution because of their hydrogen bonds with other water molecules; the hydrogen ions, consisting of naked protons, are immediately attracted to un-ionized water molecules and form hydronium ions (H30+). By convention, scientists refer to hydrogen ions and their concentration as if they were free in this state in liquid water. The concentration of hydrogen ions dissociating from pure water is 1 × 10−7 moles H+ ions per liter of water. The pH is calculated as the negative of the base 10 logarithm of this concentration: pH = −log[H+] The negative log of 1 × 10−7 is equal to 7.0, which is also known as neutral pH. Human cells and blood each maintain near-neutral pH. p Continue reading >>

Renal Physiology Acid-base Balance

Renal Physiology Acid-base Balance

Sort Your patient's blood pH is too low (acidosis), caused by metabolic acidosis. After examining the patient, you find that the urine bicarbonate levels are too low (H+ is being reabsorbed) and blood carbon dioxide levels are too high (too much blood acid); What does this mean? Based on the patient's pCO2 levels are they compensating or not? This means that the original problem of a low bicarbonate level needs to be compensated for by the lungs, which need to hyperventilate, expelling more CO2 (an acid). Since this patient's pCO2 levels are also high (not expelling enough acid), they are NOT compensating. Patient's blood pH is too high (alkalosis). This can be caused by either respiratory or metabolic alkalosis. Let's say it is metabolic alkalosis. What do you need to check to see if patient is compensating? If bicarbonate levels are high (too much base) and blood CO2 levels are high (too much acid), what do the lungs need to do to compensate? What does the patient's elevated Pco2 levels tell you? Patients partial pressure of Carbon dioxide and bicarbonate Take shallower breaths to prevent loss of acid Patient is compensating Patient's blood pH is too high (alkalosis). This can be caused by either respiratory or metabolic alkalosis. Let's say it is metabolic alkalosis. What do you need to check to see if patient is compensating? If bicarbonate levels are high (too much base) and blood CO2 levels are low (too little acid), what do the lungs need to do to compensate? Since the patient's pCO2 level is low, this tells you what? Patients pCO2 and bicarbonate Take shallower breaths to prevent loss of acid Not compensating Continue reading >>

How The Kidneys Regulate Acid Base Balance

How The Kidneys Regulate Acid Base Balance

Acid-Base Balance Everyday processes like walking, the digestion of food, and the overall metabolism in your body produce a lot of acid as a byproduct. Because of this, you'd be a giant walking lemon if it wasn't for your kidneys. What I mean is, like a lemon, you'd be filled with acid if your kidneys weren't there to help you regulate your body's pH through something we call acid-base balance. This is a process whereby receptors are able to determine the pH of your body and blood and do something about it if it's too acidic or too basic. If an imbalance in the pH is detected by your lungs, buffers, or kidneys, your body springs into action to take care of the problem. In this lesson, we'll focus in on how the kidneys help to control the acid-base balance in your body. Protons and Buffers Whereas the buffers in your body and your lungs are involved in the rapid adjustment of your blood's pH, the kidneys adjust the pH more slowly. Under normal conditions, the kidney's main role in acid-base balance is through the excretion of acid in the form of hydrogen (H+) ions. The kidneys secrete excess hydrogen ions primarily in the proximal tubule. The interesting thing to note is that while the proximal tubule secretes a lot of acid, the tubular fluid's pH remains virtually unchanged. This is because buffers filtered by the glomerulus, including phosphate and bicarbonate, help to minimize the acidity of the tubular fluid. In fact, what's really cool is that the pH of the tubular fluid, by the time it reaches the collecting duct, is about 7.4, which is exactly the pH of normal blood. The Collecting Duct However, by the time urine is excreted out of the body, it can be acidic, basic, or neutral. This is because the end-all, be-all gatekeeper in determining the final pH of urine is Continue reading >>

4.5 Respiratory Acidosis - Compensation

4.5 Respiratory Acidosis - Compensation

Acid-Base Physiology 4.5.1 The compensatory response is a rise in the bicarbonate level This rise has an immediate component (due to a resetting of the physicochemical equilibrium point) which raises the bicarbonate slightly. Next is a slower component where a further rise in plasma bicarbonate due to enhanced renal retention of bicarbonate. The additional effect on plasma bicarbonate of the renal retention is what converts an "acute" respiratory acidsosis into a "chronic" respiratory acidosis. As can be seen by inspection of the Henderson-Hasselbalch equation (below), an increased [HCO3-] will counteract the effect (on the pH) of an increased pCO2 because it returns the value of the [HCO3]/0.03 pCO2 ratio towards normal. pH = pKa + log([HCO3]/0.03 pCO2) 4.5.2 Buffering in Acute Respiratory Acidosis The compensatory response to an acute respiratory acidosis is limited to buffering. By the law of mass action, the increased arterial pCO2 causes a shift to the right in the following reaction: CO2 + H2O <-> H2CO3 <-> H+ + HCO3- In the blood, this reaction occurs rapidly inside red blood cells because of the presence of carbonic anhydrase. The hydrogen ion produced is buffered by intracellular proteins and by phosphates. Consequently, in the red cell, the buffering is mostly by haemoglobin. This buffering by removal of hydrogen ion, pulls the reaction to the right resulting in an increased bicarbonate production. The bicarbonate exchanges for chloride ion across the erythrocyte membrane and the plasma bicarbonate level rises. In an acute acidosis, there is insufficient time for the kidneys to respond to the increased arterial pCO2 so this is the only cause of the increased plasma bicarbonate in this early phase. The increase in bicarbonate only partially returns the extracel Continue reading >>

Acid-base Homeostasis

Acid-base Homeostasis

Abstract Acid-base homeostasis and pH regulation are critical for both normal physiology and cell metabolism and function. The importance of this regulation is evidenced by a variety of physiologic derangements that occur when plasma pH is either high or low. The kidneys have the predominant role in regulating the systemic bicarbonate concentration and hence, the metabolic component of acid-base balance. This function of the kidneys has two components: reabsorption of virtually all of the filtered HCO3− and production of new bicarbonate to replace that consumed by normal or pathologic acids. This production or generation of new HCO3− is done by net acid excretion. Under normal conditions, approximately one-third to one-half of net acid excretion by the kidneys is in the form of titratable acid. The other one-half to two-thirds is the excretion of ammonium. The capacity to excrete ammonium under conditions of acid loads is quantitatively much greater than the capacity to increase titratable acid. Multiple, often redundant pathways and processes exist to regulate these renal functions. Derangements in acid-base homeostasis, however, are common in clinical medicine and can often be related to the systems involved in acid-base transport in the kidneys. Basic Concepts Intracellular and extracellular buffers are the most immediate mechanism of defense against changes in systemic pH. Bone and proteins constitute a substantial proportion of these buffers. However, the most important buffer system is the HCO3−/CO2 buffer system. The Henderson–Hasselbach equation (Equation 1) describes the relationship of pH, bicarbonate (HCO3−), and PCO2:where HCO3− is in milliequivalents per liter and PCO2 is in millimeters of mercury. Equation 2 represents the reaction (water [H2O] Continue reading >>

Renal Regulation Of Metabolic Acidosis And Alkalosis

Renal Regulation Of Metabolic Acidosis And Alkalosis

1. 06/21/14 1 Normal Acid-Base Balance • Normal pH 7.35-7.45 • Narrow normal range • Compatible with life 6.8 - 8.0 ___/______/___/______/___ 6.8 7.35 7.45 8.0 Acid Alkaline 2. 06/21/14 2 PH Scale 3. 06/21/14 3 Acid & Base • Acid: • An acid is "when hydrogen ions accumulate in a solution" • It becomes more acidic • [H+] increases = more acidity • CO2 is an example of an acid. Base: A base is chemical that will remove hydrogen ions from the solution Bicarbonate is an example of a base. 4. 06/21/14 4 Acid and Base Containing Food: • To maintain health, the diet should consist of 60% alkaline forming foods and 40% acid forming foods. To restore health, the diet should consist of 80% alkaline forming foods and 20% acid forming foods. • Generally, alkaline forming foods include: most fruits, green vegetables, peas, beans, lentils, spices, herbs,seasonings,seeds and nuts. • Generally, acid forming foods include: meat, fish, poultry, eggs, grains, and legumes. 5. 06/21/14 5 Citric Acid And Lactic Acid Although both citric acid and lactic acid are acids BUT Citric acid leads to Alkalosis while Lactic acid to Acidosis due to metabolism 6. 06/21/14 6 Acidoses & Alkalosis • An abnormality in one or more of the pH control mechanisms can cause one of two major disturbances in Acid-BaseAcid-Base balance – AcidosisAcidosis – AlkalosisAlkalosis 7. 06/21/14 7 Acidosis • Acidosis is excessive blood acidity caused by an overabundance of acid in the blood or a loss of bicarbonate from the blood (metabolic acidosis), or by a buildup of carbon dioxide in the blood that results from poor lung function or slow breathing (respiratory acidosis). • Blood acidity increases when people ingest substances that contain or produce acid or when the lungs do not expel enou Continue reading >>

Renal Response To Acid-base Imbalance

Renal Response To Acid-base Imbalance

The kidneys respond to acid-base disturbances by modulating both renal acid excretion and renal bicarbonate excretion. These processes are coordinated to return the extracellular fluid pH, and thus blood pH, to normal following a derangement. Below we discuss the coordinated renal response to such acid-base disturbances. Acidosis refers to an excess extracellular fluid H+ concentration and thus abnormally low pH. The overall renal response to acidosis involves the net urinary excretion of hydrogen, resorption of nearly all filtered bicarbonate, and the generation of novel bicarbonate which is added to the extracellular fluid. Processes of renal acid excretion result in both direct secretion of free hydrogen ions, thus acidifying the urine, as well as secretion of hydrogen in the form of ammonium. These mechanisms are molecularly coupled to the generation of fresh bicarbonate, which is added to the extracellular fluid. Additionally, as discussed in renal bicarbonate excretion, nearly all filtered bicarbonate is resorbed and thus its urinary loss is minimized. Together, these processes slowly reduce ECF hydrogen ions and increase ECF bicarbonate concentrations, thus gradually raising blood pH to its normal value. Alkalosis refers to a insufficient extracellular fluid H+ concentration and thus abnormally high pH. The overall response to alkalosis involves reduced urinary secretion of hydrogen and the urinary excretion of filtered bicarbonate. Renal acid excretion is minimized in the context of alkalosis, thus preventing further increases in the ECF pH. Instead, renal bicarbonate excretion is increased, resulting in loss of bicarbonate from the extracellular fluid, and an alkalinization of the urine. Together these processes reduce ECF bicarbonate concentrations and in doin Continue reading >>

A9: Acid-base Balance

A9: Acid-base Balance

Sort Carbon dioxide is carried in the blood in all of the following forms, EXCEPT: a. it is physically dissoved in plasma b. some binds with hemoglobin to form carbamino hemoglobin c. some diffuses into the tissues d. some binds with water to form carbonic acid c (Assume the following normal values in answering the following question: pH = 7.4 pCO2 = 40 mmHg Total CO2 = 25.7 mmol/L HCO3 = 24.5 mmol/L H2CO3 = 1.2 mmol/L) A patient has a blood pH of 7.27 and a pCO2 of 62 mmHg. The HCO3- is 24.5 mmol/L. a) Is this a state of acidosis or alkalosis? b) Is the origin of the condition respiratory or metabolic and why? c) What are two conditions that can cause this? d) How will the body compensate? a) A pH of <7.4 is acidosis b) pCO2 is increased, HCO3- is normal so respiratory c) 1. Respiratory depression e.g. barbituate drugs 2. Decreased lung function e.g. pneumonia d) 1. Renal - increased HCO3-resorbtion - increased H+ secretion 2. Respiratory - hyperventilation (Assume the following normal values in answering the following question: pH = 7.4 pCO2 = 40 mmHg Total CO2 = 25.7 mmol/L HCO3 = 24.5 mmol/L H2CO3 = 1.2 mmol/L) A patient has a blood pH of 7.27, a pCO2 of 40 mmHg, [H2CO3] of 1.2 mmol/L and [HCO3-] of 22 mmol/L. a) Is this a state of acidosis or alkalosis? b) Is the origin of the condition respiratory or metabolic and why? c) What are two general causes of this condition and give a specific example of each? d) How will the body try to compensate? a) pH is <7.4 so acidosis b) HCO3is decreased, pCO2 is normal, so metabolic c) 1. Excess loss of HCO3, e.g. diarrhea 2. Accumulation of acids e.g. ketosis d) 1. Renal - increased HCO3- esorbtion - increased H+ secretion 2. Respiratory - hyperventilation In a condition of respiratory acidosis, the kidney will try to compensate Continue reading >>

How Does The Renal System Compensate For Conditions Of Respiratory Alkalosis?

How Does The Renal System Compensate For Conditions Of Respiratory Alkalosis?

In order to function normally, your body needs a blood pH of between 7.35 and 7.45. Alkalosis is when you have too much base in your blood, causing your blood pH to rise above 7.45. The lungs and the kidneys are the two main organs involved in maintaining a normal blood pH. The lungs do this by blowing off carbon dioxide, since most of the acid in the body is carbonic acid, which is made from carbon dioxide during metabolic processes. The amount of carbon dioxide removed is controlled by your breathing rate. The kidneys maintain blood pH by controlling the amount of bicarbonate, which is a base that is excreted from the body. The kidneys also control the amount of acids excreted from the body. Respiratory alkalosis occurs when the lungs are blowing off more carbon dioxide than the body is producing. This usually occurs from hyperventilation. Your body's immediate response, after about 10 minutes of respiratory alkalosis, is a process called cell buffering. During cell buffering, hydrogen ions found in hemoglobin, proteins and phosphates, move out of the cells and into the extracellular fluid. There they combine with bicarbonate molecules and form carbonic acid. This process helps to reduce the amount of bicarbonate in the body and increase the amount of acid. However, while cell buffering occurs quickly, it does not have a huge effect on the body's pH. After about two to six hours of respiratory alkalosis the kidneys respond. They begin to limit the excretion of hydrogen and other acids and increase the excretion of bicarbonate. It usually takes the kidneys two or three days to reach a new steady state. In chronic respiratory alkalosis, the pH may constantly be high, but the body learns to adapt to it over time, with the help of the kidneys. Continue reading >>

Response To Disturbances

Response To Disturbances

The body tries to minimize pH changes and responds to acid-base disturbances with body buffers, compensatory responses by the lungs and kidney (to metabolic and respiratory disturbances, respectively) and by the kidney correcting metabolic disturbances. Body buffers: There are intracellular and extracellular buffers for primary respiratory and metabolic acid-base disturbances. Intracellular buffers include hemoglobin in erythrocytes and phosphates in all cells. Extracellular buffers are carbonate (HCO3–) and non-carbonate (e.g. protein, bone) buffers. These immediately buffer the rise or fall in H+. Compensation: This involves responses by the respiratory tract and kidney to primary metabolic and respiratory acid-base disturbances, respectively. Compensation opposes the primary disturbance, although the laboratory changes in the compensatory response parallel those in the primary response. This concept is illustrated in the summary below. Respiratory compensation for a primary metabolic disturbance: Alterations in alveolar ventilation occurs in response to primary metabolic acid-base disturbances. This begins within minutes to hours of an acute primary metabolic disturbance. Note that complete compensation via this mechanism may take up to 24 hours. Renal compensation for a primary respiratory disturbance: Here, the kidney alters excretion of acid (which influences bases as well) in response to primary respiratory disturbances. This begins within hours of an acute respiratory disturbance, but take several days (3-5 days) to take full effect. Correction of acid-base changes: Correction of a primary respiratory acid-base abnormality usually requires medical or surgical intervention of the primary problem causing the acid-base disturbance, e.g. surgical relief of a colla Continue reading >>

Regulation Of Blood Ph

Regulation Of Blood Ph

Although many people are unaware of the fact, maintaining the acid/base balance of your blood is actually vital to your survival. If the pH of your blood drops below 7.2 or rises above 7.6, then very soon your brain will no longer be able to function normally and you will be in dire straits1. As luck would have it, although you cannot consciously detect your blood pH, the human body does in fact have an elegant but effective means of coping with every change in pH, large or small. This relies on three interlinking objects: buffers, the lungs and the kidneys. Buffers pH is a measurement of the concentration of hydrogen H+ ions and buffers are molecules which take in or release ions in order to maintain the H+ ion concentration at a certain level. Buffers in the blood include haemoglobin (Hb), certain proteins (Prot) and phosphates, and are the first line of defence whenever sudden changes in pH occur. When the pH is too low and the blood becomes too acidic, it is due to the presence of too many H+ ions in the blood. The buffers will attempt to mop up the excess. Conversely, a lack of H+ ions leads to the blood becoming too basic, and so the buffers release H+ ions. Buffers therefore help to maintain the pH of the blood by either sacrificing or accepting H+ ions as necessary to maintain the number of free H+ ions floating around in the blood. ← Buffer taking up excess H+ Buffer releasing H+ → H-Hb ↔ Hb- + H+ Prot-H ↔ Prot- + H+ H2PO4- ↔ HPO42- + H+ The Lungs Through these buffer reactions, the pH can be quickly corrected before any damage is done, but this does not provide a long-term solution to the problem. The buffers can only mop up or release so many H+ ions before they reach their capacity and are no longer of any use, and then the situation will once agai Continue reading >>

Acidosis

Acidosis

The kidneys and lungs maintain the balance (proper pH level) of chemicals called acids and bases in the body. Acidosis occurs when acid builds up or when bicarbonate (a base) is lost. Acidosis is classified as either respiratory or metabolic acidosis. Respiratory acidosis develops when there is too much carbon dioxide (an acid) in the body. This type of acidosis is usually caused when the body is unable to remove enough carbon dioxide through breathing. Other names for respiratory acidosis are hypercapnic acidosis and carbon dioxide acidosis. Causes of respiratory acidosis include: Chest deformities, such as kyphosis Chest injuries Chest muscle weakness Chronic lung disease Overuse of sedative drugs Metabolic acidosis develops when too much acid is produced in the body. It can also occur when the kidneys cannot remove enough acid from the body. There are several types of metabolic acidosis: Diabetic acidosis (also called diabetic ketoacidosis and DKA) develops when substances called ketone bodies (which are acidic) build up during uncontrolled diabetes. Hyperchloremic acidosis is caused by the loss of too much sodium bicarbonate from the body, which can happen with severe diarrhea. Poisoning by aspirin, ethylene glycol (found in antifreeze), or methanol Lactic acidosis is a buildup of lactic acid. Lactic acid is mainly produced in muscle cells and red blood cells. It forms when the body breaks down carbohydrates to use for energy when oxygen levels are low. This can be caused by: Cancer Drinking too much alcohol Exercising vigorously for a very long time Liver failure Low blood sugar (hypoglycemia) Medications, such as salicylates MELAS (a very rare genetic mitochondrial disorder that affects energy production) Prolonged lack of oxygen from shock, heart failure, or seve Continue reading >>

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