Causes of ion imbalance
Metabolic acidosis is a condition characterized by a decrease in bicarbonate and a reduction in (PCO2) carbon dioxide partial pressure (Mostert & Bonavia, 2016). A reduction in pH is also exhibited.Metabolic acidosis can be grouped as normal or high anion gap depending on the presence or absence of anions in the serum that have not been measured(Kraut & Kurtz, 2014). Metabolic acidosis comes about as a result of the accumulation of lactic acid and ketones, toxin and drug ingestion (High anion gap acidosis); renal failure hence decreased acid excretion and renal HCO3− or GI loss(Mostert & Bonavia, 2016). Ketoacidosis is a condition common among patients with diabetes type 1.The body shifts from glucose metabolism to free fatty acids metabolism due to insulin deficiency; the free fatty acids are converted into acetoacetic acid, keto acids, and beta-hydroxybutyrate.Glucagon stimulates ketogenesis in the absence of insulin. Osmotic dieresis occurs as a result of hyperglycemia hence excessive loss of electrolytes and water. Lactic acidosis is characterized by the accumulation of lactate that occurs mostly during anaerobic metabolism. Renal failure results into anion gap acidosis via limited acid removal and the reabsorption of HCO3−.Toxins may stimulate lactic acidosis or harbor acidic metabolites.
Hyperchloremic acidosis is also known as normal anion gap acidosis as the kidneys instead of reabsorbing HCO3− they reabsorb chloride ions. Several of GI secretions such as intestinal fluids and pancreatic fluids are rich in HCO3−.Diarrhea fistulas and tube drainage bring about acidosis through the loss of HCO3−.In diagnosis, the measurement of ABG and serum electrolytes is carried out(Weinberg, Narayanan, Moore, & Vallier, 2017).Delta and anion gaps are calculated. Winters formula is used to determine compensatory changes.
Signs and symptoms
Metabolic acidosis and some of the respiratory diseases share many symptoms. However the symptoms of metabolic acidosis vary relatively basing on the cause. Most of the symptoms and signs though are influenced by the rise of pH, carbon dioxide partial pressure (Pco2), and serum bicarbonate (HCO3−) causing rapid, mild reactions.
Most of the symptoms of metabolic acidosis tend to be caused by the underlying disease or condition that is causing the acidosis. Metabolic acidosis however, can also be referred to as a symptom depending on the cause, drug effect cause or drug interaction cause. The most common symptoms and signs of metabolic acidosis include: headaches fatigue, sleepiness, lack of appetite, jaundice, confusion, rapid and shallow breathing, increased heart rate, fruity breathe Adour, which poses as a sign of diabetic acidosis among others. In some cases where there is severe metabolic acidosis it can either lead to shock or death while in other cases it can be a mild, unremitting{ongoing} condition.
Treatment
The treatment of metabolic acidosis involves narrowing down to the main cause of the disease. The acid imbalance can affect kidneys, muscles, and bones. It can cause shock reading to death. Detoxification of either the drug or the poisoning caused by alcohol is a method that can use to treat the condition. This involves the use of chemicals or substance that neutralize the condition. In most cases, charcoal or milk can be used to neutralize the poisonous substance in the stomach before they are absorbed into the general circulation. In case of diabetic ketoacidosis, the use of insulin can help. Insulin binds to the specific receptors in the cells of the body causing the opening of the ion gated channels capable of allowing entry of glucose into the cells. Such entry allows the metabolism of glucose causing the production of the needed energy (Kim et al., 2016). The rate of ketone breakdown is therefore reduced and production of acid from such breakdown causing the imbalance is significantly reduced. Sodium bicarbonate can also be administered via intravenous. This is a buffer that can help in balancing the acidity or the basicity of blood through neutralizing the hydrogen ions or hydroxyl ions. Ms. Blake should ensure that she is administered with insulin on a regular basis.
References
Kim, K. H., Yoon, H. S., Yoon, H., Chung, W. S., Sim, B. S., Ryu, D., & Lee, D. H. (2016). Risk Factors for Developing Metabolic Acidosis after Radical Cystectomy and Ileal Neobladder. PLOS ONE, 11(7), e0158220. doi:10.1371/journal.pone.0158220
Kraut, J. A., & Kurtz, I. (2014). Treatment of acute non-anion gap metabolic acidosis. Clinical Kidney Journal, 8(1), 93-99. doi:10.1093/ckj/sfu126
Mostert, M., & Bonavia, A. (2016). Starvation Ketoacidosis as a Cause of Unexplained Metabolic Acidosis in the Perioperative Period. American Journal of Case Reports, 17, 755-758. doi:10.12659/ajcr.900002
Weinberg, D. S., Narayanan, A. S., Moore, T. A., & Vallier, H. A. (2017). Assessment of resuscitation as measured by markers of metabolic acidosis and features of injury. Bone & Joint Journal, 99-B(1), 122-127. doi:10.1302/0301-620x.99b1.bjj-2016-0418.r2
