What Are the Different Causes of Acidosis?

Acidosis refers to the accumulation of acidic substances in the blood and tissues of the body. The essence is that the concentration of hydrogen ions in the blood increases and the pH value decreases. Under pathological conditions, when [BHCO ₃ ] is reduced or [H ₂ CO ₃ ] is increased in the body, the [BHCO ₃ ] / [H ₂ CO ₃ ] ratio can be reduced, causing the pH of the blood to decrease, which is called acidosis . The accumulation of acidic substances in the blood and tissues of the body is characterized by an increase in the concentration of hydrogen ions in the blood and a decrease in the pH value.

Acidosis refers to the accumulation of acidic substances in the blood and tissues of the body. The essence is that the concentration of hydrogen ions in the blood increases and the pH value decreases. Under pathological conditions, when [BHCO ₃ ] is reduced or [H ₂ CO ₃ ] is increased in the body, the [BHCO ₃ ] / [H ₂ CO ₃ ] ratio can be reduced, causing the pH of the blood to decrease, which is called acidosis . The accumulation of acidic substances in the blood and tissues of the body is characterized by an increase in the concentration of hydrogen ions in the blood and a decrease in the pH value.

Causes of Acidosis

Metabolic acidosis

Metabolic acidosis is characterized by a primary decrease in plasma [HCO-] and a decrease in pH.

Metabolic acidosis can be divided into two categories according to whether the anion gap (AG) is increased: AG increased metabolized acidosis, and the patient's plasma [C ^l- ] level is normal, which is the normal blood chlorine metabolism often mentioned in the literature. Acidosis. Normal anion gap is a type of metabolic acidosis, but the patient's plasma [Cl-] level is elevated, that is, hyperchlorine metabolic acidosis is often mentioned in the literature.

2. Respiratory acidosis

Respiratory poisoning is characterized by an increase in plasma [H ₂ CO ₃ ] concentration and a decrease in pH.

(1) Inhibition of the respiratory center Some central nervous system diseases such as melanoma tumors, membranous polio, encephalitis, meningitis, vertebral artery embolism or thrombosis, increased intracranial pressure, and traumatic brain injury Central activity can be suppressed, reducing ventilation and CO ₂ accumulation. In addition, some drugs, such as anesthetics, sedatives, and sedatives (morphine, sodium barbiturate, etc.) can inhibit breathing. Excessive doses can cause hypoventilation. Carbonic anhydrase inhibitors such as acetazolamide have previously been described to cause metabolic acidosis. It can also inhibit carbonic anhydrase in red blood cells and reduce the release of CO ₂ from red blood cells in the lungs, causing arterial blood Pco _{2 to} increase. Patients with a tendency to acidosis should use this medicine with caution.

(2) Respiratory nerve and muscle dysfunction seen in polio, acute infectious polyneuritis (Guillain-barre syndrome), botulism, myasthenia gravis, hypokalemia or familial periodic paralysis, high spinal cord injury Wait. In severe cases, the respiratory muscles can be paralyzed.

(3) thoracic abnormalities Common thoracic abnormalities that affect respiratory movements include spine, scoliosis, flail chest, Ankylosing Spondylitis, and cardiopulmonary obesity syndrome (Picwick syndrome).

(4) Airway obstruction Common foreign body obstruction, throat edema, and inhalation of vomitus are common.

(5) Extensive lung disease is the most common cause of respiratory acidosis. It includes chronic obstructive pulmonary disease, bronchial asthma, and severe interstitial lung disease. These lesions can severely prevent alveolar ventilation.

(6) Excessive CO ₂ inhalation means that the concentration of CO _{2 in the} inhaled gas is too high, such as in tunnels, tanks, and other spaces with poor ventilation. Alveolar ventilation did not decrease at this time.

Acidosis diagnosis

1. Immediately after admission, blood routine, hematocrit, blood gas analysis, carbon dioxide binding power, blood sodium, potassium, chlorine, calcium, phosphorus, urea nitrogen, and blood potassium, sodium, chlorine, blood gas and carbon dioxide binding power 1 day or every other day until normal. Immediately measure urine routine, ketone body, sodium, potassium, chlorine, calcium, phosphorus and pH.

2. ECG examination, check each time before treatment and 4 to 6 hours after the start of treatment, and review as appropriate. If necessary, measure the blood lactic acid content.

3. Record the amount of liquid in and out within 24 hours, especially pay attention to urine output.

Acidosis treatment

1. According to the general nursing routine of internal medicine. Rest in bed and stay warm.

2. Etiology treatment.

3. If there is dehydration, give 5% glucose solution and saline solution intravenously, and decide the amount of fluid replacement according to the condition.

4. Alkaline medicine can choose 5% sodium bicarbonate intravenous drip, or 11.2% sodium lactate (except lactic acidosis). Those who avoid using sodium salt can choose 7.28% tromethamine (THAM) to dilute and then instill. The above drugs can be repeated 1 to 2 times a day depending on the clinical manifestations and blood gas analysis results.

5. Treatment of critically ill patients with alkaline drugs.

6. Correct the electrolyte disturbance according to the test results.

7. Convulsions after correcting acidosis may be hypocalcemia.