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Concept
Acid–base disorder
Summary
Acid–base imbalance is an abnormality of the human body's normal balance of acids and bases that causes the plasma pH to deviate out of the normal range (7.35 to 7.45). In the fetus, the normal range differs based on which umbilical vessel is sampled (umbilical vein pH is normally 7.25 to 7.45; umbilical artery pH is normally 7.18 to 7.38). It can exist in varying levels of severity, some life-threatening.
An excess of acid is called acidosis or acidemia, while an excess in bases is called alkalosis or alkalemia. The process that causes the imbalance is classified based on the cause of the disturbance (respiratory or metabolic) and the direction of change in pH (acidosis or alkalosis). This yields the following four basic processes:
The presence of only one of the above derangements is called a simple acid–base disorder. In a mixed disorder, more than one is occurring at the same time. Mixed disorders may feature an acidosis and alkosis at the same time that partially counteract each other, or there can be two different conditions affecting the pH in the same direction. The phrase "mixed acidosis", for example, refers to metabolic acidosis in conjunction with respiratory acidosis. Any combination is possible, as metabolic acidosis and alkalosis can co exist together.
The traditional approach to the study of acid–base physiology has been the empirical approach. The main variants are the base excess approach and the bicarbonate approach. The quantitative approach introduced by Peter A Stewart in 1978 is newer.
There are numerous reasons that each of the four processes can occur (detailed in each article). Generally speaking, sources of acid gain include:
Retention of carbon dioxide
Production of nonvolatile acids from the metabolism of proteins and other organic molecules
Loss of bicarbonate in feces or urine
Intake of acids or acid precursors
Sources of acid loss include:
Use of hydrogen ions in the metabolism of various organic anions
Loss of acid in the vomitus or urine
Gastric aspiration in hospital
Severe diarrhea
Carbon dioxide loss through hyperventilation
The body's acid–base balance is tightly regulated.
Official source
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