Metabolic acidosis
| Classification according to ICD-10 | |
|---|---|
| E87.2 | Acidosis Metabolic Acidosis |
| ICD-10 online (WHO version 2019) | |
In medicine, metabolic acidosis is a metabolic acidification of the blood and body ( acidosis ). It is caused by increased protons accumulating in the body's metabolism , by their reduced excretion and / or by a loss of bicarbonate .
causes
The most common causes of metabolic acidosis (if not caused by chronic malnutrition) are
- chronic renal insufficiency with uremia or distal tubular acidosis with an isolated tubular H + secretion defect of the kidneys ( retention acidosis ),
- diabetic metabolic derangement with ketoacidosis in the case of absolute insulin deficiency , lactic acidosis (both addition acidoses - enlarged anion gap ),
- Poisoning with acidic substances such as acetylsalicylic acid (also an addition acidosis )
- Loss of bicarbonate ions in the proximal tubule or in the event of diarrhea (subtractive acidosis).
The most common metabolic acidosis is diabetic ketoacidosis. With a lack of insulin, the diabetic gains energy through the increased burning of fatty acids , since he cannot use glucose . This increased fat breakdown creates ketone bodies that bind large amounts of bicarbonate buffer . The resulting relative deficiency of bicarbonate leads to acidification of the blood.
diagnosis
A patient with metabolic acidosis is particularly noticeable because of his intensified, deep, normofrequency breathing (so-called Kussmaul breathing ). With ketoacidosis in diabetics, one can usually notice a fruity acetone smell in the air. Blood gas analysis is crucial for the detection and quantification of metabolic acidosis . From the base deficit, pH and the CO 2 - partial pressure of the extent of metabolic acidosis and extent of the respiratory compensation of the body can be easily recognized. The causes can be further differentiated on the basis of the anion gap .
therapy
Treatment of the cause is the main therapeutic focus. But also through symptomatic treatment, e.g. B. by giving insulin, diabetic ketoacidosis can be improved very quickly. It is also important to ensure that there is sufficient fluid and electrolyte intake. Dialysis must be attempted in the case of uremia . By administering sodium hydrogen carbonate or other buffer substances, one can try to at least temporarily limit the metabolic dysfunction of metabolic acidosis. However, due to serious disadvantages such as electrolyte derailments, this is only carried out in severe acidosis with a pH <7.1.
literature
- Albrecht Schwab: Breathing and Acid-Base Balance . In: Michael Gekle et al. (Ed.): Pocket textbook Physiology . Thieme Verlag, Stuttgart 2010, ISBN 978-3-13-144981-8 , p. 320-334 .
