Impaired acid-base balance (pH) is a condition when the acid and base levels in the blood are not balanced. This condition can interfere with the work of various organs of the body.
Blood acid-base levels play an important role in helping various body functions, such as digestion, metabolism, and hormone production. Therefore, acid-base levels must always be balanced so that body functions work properly (homeostasis).
The level of acid-base in the blood is measured by the pH scale, from 0 (very acidic) to 14 (very alkaline). Normally, normal blood pH levels range from 7.35–7.45.
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 and is called alkalosis.
Types of Acid Base Balance Disorders
The body uses various mechanisms to regulate the acid-base balance in the blood. This mechanism involves the lungs, kidneys, and the buffer system .
Regulation of the blood pH balance in the lungs occurs in the process of breathing. Humans breathe by inhaling oxygen (O 2 ) and exhaling carbon dioxide (CO 2 ). CO 2 is an acidic substance so that the amount of CO released will affect the pH balance of the blood, both acidosis and 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 if the production of acids and bases in the body is not balanced. This condition occurs when the kidneys cannot remove excess acid or base from the body. Acidosis and alkalosis resulting from either of the two conditions above is called metabolic acidosis and metabolic alkalosis.
Causes of Acid Base Balance Disorders
The causes of acid-base balance disorders depend on the type. Respiratory acidosis and respiratory alkalosis are caused by disorders of the lungs. Meanwhile, metabolic acidosis and metabolic alkalosis are triggered by disorders of the kidneys. Here is the explanation:
Respiratory acidosis is caused by lung disease or other conditions that affect the function of the lungs to remove carbon dioxide (CO 2 ). In other words, respiratory acidosis occurs when the body can get rid of only a small amount of CO 2 .
Respiratory acidosis can occur suddenly (acute) or last a long time (chronic). A number of conditions that can trigger acute respiratory acidosis are:
- Heart failure
- Chronic obstructive pulmonary disease
- Disorders of the nervous system and muscles, eg myasthenia gravis , Guillain-Barré syndrome , or muscular dystrophy
- Disorders of the nervous system or weakness of the respiratory muscles due to the use of certain drugs
Meanwhile, chronic respiratory acidosis is generally caused by the following conditions:
- Lung diseases, such as asthma, pneumonia , and emphysema
- Blockage in the respiratory tract
- Sleep apnea
- Obesity hypoventilation syndrome (OHS)
- Disorders of the muscular and nervous systems, such as amyotrophic lateral sclerosis (ALS)
Metabolic acidosis occurs when the body produces too much acid or when the kidneys are only able to remove a small amount of acid through the urine. Metabolic acidosis is divided into several types, namely:
Ketodiabetic acidosis or diabetic ketoacidosis
Ketodiabetic acidosis occurs when the levels of acidic ketones in the blood increase due to a lack of insulin in the body. 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 due to diarrhea
acidosis Lactic acidosis occurs when the body has an excess of lactic acid. This condition is caused by consumption of alcoholic beverages ( alcoholic ketoacidosis ), cancer, heart failure, seizures, liver failure, sepsis, or excessive exercise
In addition to the above conditions, metabolic acidosis can also be caused by kidney disease , severe dehydration, and aspirin poisoning.
Respiratory alkalosis is generally caused by hyperventilation, which is a condition when a person breathes too fast or too deeply. As a result , a lot of CO2 will be inhaled and enter the bloodstream. Hyperventilation can be caused by:
- Anxiety disorders
- Panic attack
- Sepsis or other infectious disease
- Liver disease
- High fever
Metabolic alkalosis occurs when a person's body lacks acid or excess base. Some things that can trigger this condition are:
- Prolonged vomiting so that the body lacks electrolytes
- Excessive use of diuretics or ulcer drugs (antacids)
- Sindrom Cushing
Symptoms of Acid Base Balance Disorders
Symptoms of acid-base balance disorders depend on the type of disorder experienced. The following are the symptoms of each acid-base balance disorder, namely:
Respiratory acidosis can occur suddenly (acute) or long-term (chronic). In general, chronic respiratory acidosis does not cause any symptoms. However, in some cases, sufferers can experience memory loss, sleep disturbances, and personality changes.
Whereas acute respiratory acidosis initially causes complaints of headaches, anxiety, anxiety, confusion, and blurred vision. If not treated immediately, other symptoms will appear such as weakness, shortness of breath, decreased consciousness, to coma .
Symptoms of metabolic acidosis are quite diverse. Some sufferers of this condition generally have fruity breath. These symptoms are signs of diabetic ketoacidosis .
Diabetic ketoacidosis is a metabolic acidosis that occurs in diabetic patients. This condition is dangerous, because it can interfere with liver and kidney function.
Symptoms of metabolic acidosis include:
- Easily tired
- Nausea and vomiting
- Easy to sleepy
- Loss of appetite
- Quick and deep breaths
- Increased heart rate
A common symptom of respiratory alkalosis is breathing that is too fast or too deep (hyperventilation). Other symptoms of respiratory alkalosis are:
- Dry mouth
- Muscle cramps in hands and feet
- Chest pain
- Hard to breathe
- Heart rhythm disturbances
Patients with metabolic alkalosis generally experience hypoventilation, which is a condition when the patient breathes too slowly or too shallowly. This condition causes too little oxygen in the blood. On the other hand, the level of carbon dioxide in the body increases.
Hypokalemia or low levels of potassium in the blood also often accompany metabolic alkalosis. Therefore, sufferers may experience symptoms such as fatigue, muscle aches, frequent urination (polyuria), or heart rhythm disturbances ( arrhythmias ).
Other symptoms in people with metabolic alkalosis include:
- Bluish skin or nails
- Breath slow down
- Muscle cramps and spasms
- Get angry easily
- Respiratory disorders
When to go to the doctor
Immediately check with your doctor if you experience the symptoms as mentioned above. You also have to be vigilant if there is a worsening of symptoms accompanied by an emergency condition, such as:
- Hard to breathe
- Loss of consciousness or fainting
If possible, go to the ER immediately or call an ambulance at 119 for immediate emergency treatment.
Diagnosis of Acid Base Balance Disorders
The doctor will ask about the symptoms experienced and the patient's medical history. After that, the doctor will carry out several tests to diagnose acid-base balance disorders, namely:
1. Blood gas analysis
This examination is carried out by taking a patient's blood sample through an artery in the wrist, arm, or groin. Blood gas analysis aims to measure elements that affect acid-base balance, namely:
- blood pH
- Bikarbonat (HCO 3 -)
- Oxygen saturation (SaO 2 )
- Oxygen partial pressure (PaO 2 )
- Partial pressure of carbon dioxide (PaCO 2 )
2. 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. As well as being used to measure blood pH levels, this test also measures blood sugar, protein, calcium, and electrolytes.
3. Examination of the lungs
In patients suspected of having respiratory acidosis, the doctor will run a chest X-ray to see the condition of the patient's lungs. Doctors may also run lung function tests , such as spirometry, to measure the amount of air inhaled and exhaled.
Another test that can be done is plethysmography , which is a procedure to measure the volume of air in the patient's lungs.
4. Tes urine
Apart from examining blood samples, acid-base balance disorders can be diagnosed through a urine test (urinalysis). Through urinalysis, doctors can find out if there are changes in acid-base levels in patients.
Treatment of Acid Base Balance Disorders
The method of treating acid-base balance disorders will be adjusted to the cause. The following is an explanation:
One method of treatment for respiratory acidosis is the administration of drugs, including:
- Antibiotics, to treat infection
- 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 with the continuous positive airway pressure (CPAP) method. In this therapy, the patient will be asked to wear a mask over the nose and/or mouth. The mask is connected to a machine that blows air into the respiratory tract to keep the airway open.
Treatment of metabolic acidosis depends on the underlying cause, including:
- Sodium bicarbonate infusion in hyperchloremic acidosis
- Insulin injections in patients with diabetic acidosis
- Administration of body fluid replacement by injection
- Detoxification in acidosis due to drug or alcohol poisoning
In patients with lactic acidosis, doctors can provide bicarbonate supplements or body fluid replacement injections. Doctors can also give antibiotics or oxygen therapy.
In respiratory alkalosis caused by hyperventilation, the doctor may suggest that the patient inhale carbon dioxide (CO 2 ), by exhaling into a paper bag, then inhaling it again. This method must be repeated several times to help raise CO2 levels in the blood .
Please note that the above method should only be used if the doctor has confirmed that the acid-base balance disorder is caused by hyperventilation. If you are experiencing these symptoms for the first time, seek medical attention immediately to the hospital.
In some cases, doctors can provide the following types of drugs to treat metabolic alkalosis:
- Diuretics, such as acetazolamide or spironolactone
- ACE inhibitors , such as captopril and lisinopril
- Corticosteroids, such as dexamethasone
- Administration of potassium supplements
- Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen
- Administration of fluids by infusion
Complications of Acid Base Balance Disorders
Disorders of acid-base balance that are not treated can cause complications. In acidosis, complications that can occur include:
- Kidney disorders
- bone disease
- The process of growth and development is hampered
- Damage to organ function
- Respiratory system failure
Like acidosis, untreated alkalosis can lead to a number of complications, including:
- Heart rhythm disturbances ( arrhythmias )
- Electrolyte disturbances, especially hypokalemia
Prevention of Acid Base Balance Disorders
Acidosis cannot be completely prevented. However, there are steps you can take to reduce the risk. How to prevent it depends on the type of acidosis experienced, namely:
Prevention of respiratory acidosis:
- Quit smoking to prevent lung damage
- Maintain an ideal body weight, because excess weight can make you have trouble breathing
Prevention of metabolic acidosis:
- Maintain sufficient body fluids by drinking lots of fluids
- Controlling blood sugar to prevent ketoacidosis, if you have diabetes mellitus
- Stop consuming alcoholic beverages to prevent the buildup of lactic acid
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.
To prevent dehydration, the doctor will suggest the following:
- Drink 8-10 glasses of water per day
- Drink regularly before, during, and after exercise
- Drink electrolyte replacement while doing strenuous exercise
- Avoid drinks with high sugar content, such as soda
- Limit caffeinated drinks, such as coffee and tea
Especially for respiratory alkalosis, prevention can be done by treating the causes of hyperventilation, such as stress and panic. The trick is to do meditation, breathing exercises, or regular exercise.