Acid-Base Balance and Imbalance

Acid-base balance

Human beings’ blood needs a balance in acidic and alkaline compounds to function properly. The balance is commonly referred to as the acid-base balance. Variations in the balance can cause damage to the essential organs in the human body. As a result, kidneys and lungs help to maintain the balance. Acid and alkaline levels are measured using a PH scale. Increased acid levels in the body lead to a fall in PH levels, while increased alkaline levels cause the PH to rise. Some common conditions that arise as a result of irregularities in the acid-base balance include respiratory acidosis, respiratory alkalosis, and metabolic acidosis.

Respiratory acidosis

The condition occurs when the lungs fail to remove excess carbon dioxide from the body, thus causing the blood and other body fluids in the body to become too acidic. An individual with respiratory acidosis will experience confusion, fatigue, and shortness of breath (Patel & Sharma, 2019). Several factors can cause the condition, including obesity, chest deformities, overuse of sedatives, or chronic lung and airway diseases. Chronic respiratory acidosis and acute respiratory acidosis are the two types of respiratory acidosis known. Chronic respiratory acidosis has no symptoms due to its gradual nature of occurrence that allows the kidneys to adjust and compensate and thus returning the blood to a balanced state. Conversely, acute respiratory acidosis occurs suddenly.     

Diagnostic testing for respiratory acidosis includes arterial blood gas test, metabolic panel, pulmonary function test, and chest X-ray. Acute respiratory acidosis requires immediate treatment by the doctor, and the therapy targets the cause.  A patient experiencing air obstruction may be given bronchodilator medications, whereas low oxygen concentration in the blood is treated using a breathing machine or noninvasive positive pressure ventilation. Chronic respiratory acidosis may be caused by an infection, inflammation, or an organ deformity, and thus, treatment requires addressing the cause. Its complications include shock, organ failure, or respiratory failure. Prevention measures include maintaining a healthy weight, following a doctor’s advice strictly when taking sedatives, and avoiding smoking.

Respiratory alkalosis

Respiratory alkalosis occurs due to an increase in alveolar ventilation, which causes excessive elimination of carbon dioxide from the blood. The disease is defined as a state where the body’s pH is greater than 7.45. It happens when an individual breath too deep or fast in a condition known as hyperventilation or over-breathing, thus causing carbon dioxide levels to drop too low, causing the blood to be excessively alkaline (Langer & Caironi, 2016).  The causes of hyperventilation include panic attacks, anxiety, heart attacks, drug use, fever, pregnancy, pulmonary embolism, asthma, pain, or chronic obstructive pulmonary disease.

Symptoms of the condition include dizziness, bloating, feeling of short breath, confusion, dry mouth, discomfort in the chest area, tingling in the arms, and heart palpitations. The treatment of respiratory alkalosis depends on the cause, but all treatments target to increase the carbon dioxide level in the blood. The condition can be prevented by addressing any risk factors of hyperventilation. The condition is significantly related to psychological conditions such as stress and anxiety, and thus controlling the elements may help reduce its chances of occurring.

 Metabolic acidosis

Metabolic acidosis occurs when an individual’s body produces excessive acid or when the kidneys fail to eliminate acid properly. The symptoms of the condition include rapid breathing, confusion, and fatigue (Dounousi et al., 2015). There exist three types of metabolic acidosis. One common type is the diabetic acidosis, also known as diabetic ketoacidosis, and which occurs as a result of ketone bodies build up. Diabetic ketoacidosis is caused by uncontrolled type 1 diabetes. Another type is hyperchloremic acidosis, which occurs when the body experiences a significant loss of sodium bicarbonate, especially after undergoing severe diarrhea.   

  The third type is lactic acidosis caused by lactic acid build-up. The excessive lactic acid in the body may be due to prolonged exercise, certain medications, alcohol, seizures, severe dehydration, liver failure, excessive drinking, lack of oxygen, low blood sugar, or cancer, among other causes. The diagnostic testing of metabolic acidosis includes serum electrolytes, arterial blood gases, and urine pH. A doctor is required to conduct more tests to establish the cause once the condition is confirmed. Its treatment involves treating the underlying cause. A doctor may also prescribe sodium bicarbonate to return the blood to a normal PH.  Severe cases of metabolic acidosis can lead to serious conditions such as shock.


Dounousi, E., Zikou, X., Koulouras, V., & Katopodis, K. (2015). Metabolic acidosis during parenteral nutrition: pathophysiological mechanisms. Indian journal of critical care medicine: peer-reviewed, official publication of Indian Society of Critical Care Medicine, 19(5), 270.

Langer, T., & Caironi, P. (2016). Pathophysiology and therapeutic strategy of respiratory alkalosis.

Patel, S., & Sharma, S. (2019). Physiology, Respiratory Acidosis. In StatPearls [Internet]. StatPearls Publishing.

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