Merck Manual

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James L. Lewis III

, MD, Brookwood Baptist Health and Saint Vincent’s Ascension Health, Birmingham

Reviewed/Revised Jul 2023

Acidosis is caused by an overproduction of acid that builds up 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).

  • Blood acidity increases when people ingest substances that contain or produce acid or when the lungs do not expel enough carbon dioxide.

  • People with metabolic acidosis often have nausea, vomiting, and fatigue and may breathe faster and deeper than normal.

  • People with respiratory acidosis often have headache and confusion, and breathing may appear shallow, slow, or both.

  • Tests on blood samples typically show pH below the normal range.

  • Doctors treat the cause of the acidosis.

If an increase in acid overwhelms the body's acid-base control systems Control of Acid-Base Balance An important part of being healthy is for the blood to maintain a normal degree of acidity or alkalinity. The acidity or alkalinity of any solution, including blood, is indicated on the pH scale... read more , 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, which raises the blood pH back toward normal.

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.

Blood pH

Acidity and alkalinity are expressed on the pH scale, which ranges from 0 (strongly acidic) to 14 (strongly basic or alkaline). A pH of 7.0, in the middle of this scale, is neutral.

Blood is normally slightly basic, with a normal pH range of 7.35 to 7.45. Usually the body maintains the pH of blood close to 7.40.

Causes of Acidosis

Acidosis is categorized depending on its primary cause as

  • Metabolic

  • Respiratory

Metabolic acidosis

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). Many other medications and poisons can cause acidosis.

Even the production of normal amounts of acid may lead to acidosis when the kidneys are not functioning normally (kidney failure Overview of Kidney Failure Kidney failure is the inability of the kidneys to adequately filter metabolic waste products from the blood. Kidney failure has many possible causes. Some lead to a rapid decline in kidney function... read more ) and are therefore not able to excrete sufficient amounts of acid in the urine.

Metabolic acidosis also develops when the body loses too much base. For example, bicarbonate can be lost through the digestive tract due to diarrhea.

Respiratory acidosis

Respiratory acidosis can also develop when disorders of the brain or of the nerves or muscles of the chest (such as Guillain-Barré syndrome Guillain-Barré Syndrome (GBS) Guillain-Barré syndrome is a form of polyneuropathy causing muscle weakness, which usually worsens over a few days to weeks, then slowly improves or returns to normal on its own. With treatment... read more or amyotrophic lateral sclerosis Amyotrophic Lateral Sclerosis (ALS) and Other Motor Neuron Diseases (MNDs) Motor neuron diseases are characterized by progressive deterioration of the nerve cells that initiate muscle movement. As a result, the muscles stimulated by these nerves deteriorate, become... read more ) impair breathing. In addition, people can develop respiratory acidosis when their breathing is slowed due to oversedation as a result of opioids (narcotics), alcohol, or strong drugs that induce sleep (sedatives). As a result of the slowed breathing, the level of oxygen in the blood may be low.

Symptoms of Acidosis

In mild metabolic acidosis, people may have no symptoms but usually experience

  • Fatigue

  • Nausea

  • Vomiting

Breathing becomes deeper and slightly faster (as the body tries to correct the acidosis by expelling more carbon dioxide). As the acidosis worsens, people begin to feel extremely weak and drowsy and may feel confused and increasingly nauseated. Eventually, in severe cases, heart problems may develop and blood pressure can fall, leading to shock, coma, and death.

In respiratory acidosis, the earliest symptoms are

  • Drowsiness

  • Headache

Drowsiness may progress to stupor and coma as the oxygen in the blood becomes inadequate. Stupor and coma can develop within moments if breathing stops or is severely impaired, or over hours if breathing is less dramatically impaired.

Diagnosis of Acidosis

  • Blood tests

The diagnosis of acidosis generally requires the measurement of blood pH and carbon dioxide in a sample of arterial blood, usually taken from the radial artery in the wrist. Arterial blood is used because venous blood is generally not as reliable when measuring the body’s pH status.

To learn more about the cause of the acidosis, doctors also measure the levels of bicarbonate in the blood. Additional blood tests are then done to help determine the specific cause.

Treatment of Acidosis

  • Treatment of the cause

  • Sometimes fluids with bicarbonate given by vein

Almost always, treatment of acidosis is directed at reversing the cause. Doctors rarely simply give alkaline medications, such as bicarbonate, to reverse the acidosis.

In metabolic acidosis, treatment depends primarily on the cause. For instance, treatment may be needed to control diabetes with insulin or to remove the toxic substance from the blood in cases of poisoning.

In respiratory acidosis, treatment aims at improving the function of the lungs. Medications that open the airways (bronchodilators, such as albuterol) may help people who have lung diseases such as asthma and chronic obstructive pulmonary disease. Sedation due to medications and other substances can sometimes be reversed by antidotes. People who have severely impaired breathing or lung function, for whatever reason, may need mechanical ventilation Mechanical Ventilation Mechanical ventilation is use of a machine to aid the movement of air into and out of the lungs. Some people with respiratory failure need a mechanical ventilator (a machine that helps air get... read more to aid breathing.

Severe acidosis may also be treated directly when it does not respond to efforts to treat the cause. In such cases, bicarbonate may be given intravenously. However, bicarbonate provides only temporary relief (treatment of the cause should continue) and may cause harm—for instance, by overloading the body with sodium and water.

Drugs Mentioned In This Article

Generic Name Select Brand Names
Afrezza, Exubera
Accuneb, ProAir digihaler, Proair HFA, ProAir RespiClick, Proventil, Proventil HFA, Proventil Repetabs, Respirol , Ventolin, Ventolin HFA, Ventolin Syrup, Volmax, VoSpire ER
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