{"id":7694,"date":"2024-12-05T16:18:04","date_gmt":"2024-12-05T21:18:04","guid":{"rendered":"https:\/\/pressbooks.bccampus.ca\/pathology\/chapter\/compensation-gj-betts-clone\/"},"modified":"2025-11-11T23:44:59","modified_gmt":"2025-11-12T04:44:59","slug":"compensation-gj-betts-clone","status":"publish","type":"chapter","link":"https:\/\/pressbooks.bccampus.ca\/pathology\/chapter\/compensation-gj-betts-clone\/","title":{"raw":"Acid Base Disorders and Compensation","rendered":"Acid Base Disorders and Compensation"},"content":{"raw":"<div class=\"textbox textbox--learning-objectives\"><header class=\"textbox__header\">\r\n<p class=\"textbox__title\">Learning Objectives<\/p>\r\n\r\n<\/header>\r\n<div class=\"textbox__content\">\r\n\r\nBy the end of this section, you will be able to:\r\n<ul>\r\n \t<li>Identify the three blood variables considered when making a diagnosis of acidosis or alkalosis.<\/li>\r\n \t<li>Identify the source of compensation for blood pH problems of a respiratory origin.<\/li>\r\n \t<li>Identify the source of compensation for blood pH problems of a metabolic or renal origin.<\/li>\r\n<\/ul>\r\n<\/div>\r\n<\/div>\r\n<p id=\"fs-id1615929\">Normal arterial blood pH is restricted to a very narrow range of 7.35 to 7.45. A person who has a blood pH below 7.35 is considered to be in acidosis (actually, \u201cphysiological acidosis,\u201d because blood is not truly acidic until its pH drops below 7), and a continuous blood pH below 7.0 can be fatal. Acidosis has several symptoms, including headache and confusion, and the individual can become lethargic and easily fatigued (<a class=\"autogenerated-content\" href=\"#AcidosisAlkalosisSymptoms\">Symptoms of Acidosis and Alkalosis<\/a>). A person who has a blood pH above 7.45 is considered to be in alkalosis, and a pH above 7.8 is fatal. Some symptoms of alkalosis include cognitive impairment (which can progress to unconsciousness), tingling or numbness in the extremities, muscle twitching and spasm, and nausea and vomiting. Both acidosis and alkalosis can be caused by either metabolic or respiratory disorders.<\/p>\r\n<p id=\"fs-id1416028\">As discussed earlier in this chapter, the concentration of carbonic acid in the blood is dependent on the level of CO<sub>2<\/sub>\u00a0in the body and the amount of CO<sub>2<\/sub>\u00a0gas exhaled through the lungs. Thus, the respiratory contribution to acid-base balance is usually discussed in terms of CO<sub>2<\/sub>\u00a0(rather than of carbonic acid). Remember that a molecule of carbonic acid is lost for every molecule of CO<sub>2<\/sub>\u00a0exhaled, and a molecule of carbonic acid is formed for every molecule of CO<sub>2<\/sub> retained.<\/p>\r\n\r\n\r\n[caption id=\"attachment_9614\" align=\"aligncenter\" width=\"680\"]<img class=\" wp-image-9614\" src=\"https:\/\/pressbooks.bccampus.ca\/pathology\/wp-content\/uploads\/sites\/1260\/2025\/08\/2716_Symptoms_of_Acidosis_Alkalosis.jpg\" alt=\"This figure points out the symptoms of acidosis and alkalosis on a silhouette of a human torso. The effects of acidosis on the central nervous system include headache, sleepiness, confusion, loss of consciousness and coma. The effects of acidosis are given on the left side of the diagram. The effects of acidosis on the respiratory system include shortness of breath and coughing. The effects of acidosis on the heart include arrhythmia and increased heart rate. The effects of acidosis on the muscular system include seizures and weakness. The effects of acidosis on the digestive system include nausea, vomiting and diarrhea. The right side of the diagram describes the symptoms of alkalosis. The effects of alkalosis on the central nervous system include confusion, light-headedness, stupor, and coma. The effects of alkalosis on the peripheral nervous system include hand tremor and numbness or tingling in the face, hands, and feet. The effects of alkalosis on the muscular system include twitching and prolonged spasms. The effects of alkalosis on the digestive system include nausea and vomiting.\" width=\"680\" height=\"441\" \/> <strong>Symptoms of Acidosis and Alkalosis<\/strong> - Symptoms of acidosis affect several organ systems. Both acidosis and alkalosis can be diagnosed using a blood test.[\/caption]\r\n<h2 data-type=\"title\">Metabolic Acidosis: Primary Bicarbonate Deficiency<\/h2>\r\n<span id=\"term-00001\" data-type=\"term\">Metabolic acidosis<\/span>\u00a0occurs when the blood is too acidic (pH below 7.35) due to too little bicarbonate, a condition called primary bicarbonate deficiency. At the normal pH of 7.40, the ratio of bicarbonate to carbonic acid buffer is 20:1. If a person\u2019s blood pH drops below 7.35, then the person is in metabolic acidosis. The most common cause of metabolic acidosis is the presence of organic acids or excessive ketone bodies in the blood.\u00a0The table below\u00a0lists some other causes of metabolic acidosis.\r\n<div class=\"os-table os-top-titled-container\">\r\n<div class=\"os-table-title\" style=\"text-align: center\"><strong>Common Causes of Metabolic Acidosis and Blood Metabolites<\/strong><\/div>\r\n<table id=\"tbl-ch27_02\" class=\"top-titled aligncenter\" style=\"width: 490px;height: 166px\">\r\n<thead>\r\n<tr style=\"height: 15px\">\r\n<th style=\"width: 150.938px;height: 15px\" scope=\"col\">Cause<\/th>\r\n<th style=\"width: 310.188px;height: 15px\" scope=\"col\">Metabolite<\/th>\r\n<\/tr>\r\n<\/thead>\r\n<tbody>\r\n<tr style=\"height: 15px\">\r\n<td style=\"width: 151.438px;height: 15px\">Diarrhea<\/td>\r\n<td style=\"width: 310.688px;height: 15px\">Bicarbonate<\/td>\r\n<\/tr>\r\n<tr style=\"height: 15px\">\r\n<td style=\"width: 151.438px;height: 15px\">Uremia<\/td>\r\n<td style=\"width: 310.688px;height: 15px\">Phosphoric, sulfuric, and lactic acids<\/td>\r\n<\/tr>\r\n<tr style=\"height: 15px\">\r\n<td style=\"width: 151.438px;height: 15px\">Diabetic ketoacidosis<\/td>\r\n<td style=\"width: 310.688px;height: 15px\">Increased ketone bodies<\/td>\r\n<\/tr>\r\n<tr style=\"height: 15px\">\r\n<td style=\"width: 151.438px;height: 15px\">Strenuous exercise<\/td>\r\n<td style=\"width: 310.688px;height: 15px\">Lactic acid<\/td>\r\n<\/tr>\r\n<tr style=\"height: 15px\">\r\n<td style=\"width: 151.438px;height: 15px\">Methanol<\/td>\r\n<td style=\"width: 310.688px;height: 15px\">Formic acid*<\/td>\r\n<\/tr>\r\n<tr style=\"height: 15px\">\r\n<td style=\"width: 151.438px;height: 15px\">Paraldehyde<\/td>\r\n<td style=\"width: 310.688px;height: 15px\">\u03b2-Hydroxybutyric acid*<\/td>\r\n<\/tr>\r\n<tr style=\"height: 15px\">\r\n<td style=\"width: 151.438px;height: 15px\">Isopropanol<\/td>\r\n<td style=\"width: 310.688px;height: 15px\">Propionic acid*<\/td>\r\n<\/tr>\r\n<tr style=\"height: 31px\">\r\n<td style=\"width: 151.438px;height: 31px\">Ethylene glycol<\/td>\r\n<td style=\"width: 310.688px;height: 31px\">Glycolic acid, and some oxalic and formic acids*<\/td>\r\n<\/tr>\r\n<tr style=\"height: 15px\">\r\n<td style=\"width: 151.438px;height: 15px\">Salicylate\/aspirin<\/td>\r\n<td style=\"width: 310.688px;height: 15px\">Sulfasalicylic acid (SSA)*<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<div class=\"os-caption-container\" style=\"text-align: center\">\u00a0<span class=\"os-caption\">*Acid metabolites from ingested chemical.<\/span><\/div>\r\n<\/div>\r\nThe first three of the eight causes of metabolic acidosis listed are medical (or unusual physiological) conditions. Strenuous exercise can cause temporary metabolic acidosis due to the production of lactic acid. The last five causes result from the ingestion of specific substances. The active form of aspirin is its metabolite, sulfasalicylic acid. An overdose of aspirin causes acidosis due to the acidity of this metabolite. Metabolic acidosis can also result from uremia, which is the retention of urea and uric acid. Metabolic acidosis can also arise from diabetic ketoacidosis, wherein an excess of ketone bodies are present in the blood. Other causes of metabolic acidosis are a decrease in the excretion of hydrogen ions, which inhibits the conservation of bicarbonate ions, and excessive loss of bicarbonate ions through the gastrointestinal tract due to diarrhea.\r\n\r\n<section id=\"fs-id1247876\" data-depth=\"1\">\r\n<h2 data-type=\"title\">Metabolic Alkalosis: Primary Bicarbonate Excess<\/h2>\r\n<p id=\"fs-id1721352\"><span id=\"term-00002\" data-type=\"term\">Metabolic alkalosis<\/span>\u00a0is the opposite of metabolic acidosis. It occurs when the blood is too alkaline (pH above 7.45) due to too much bicarbonate (called primary bicarbonate excess).<\/p>\r\n<p id=\"fs-id1249408\">A transient excess of bicarbonate in the blood can follow ingestion of excessive amounts of bicarbonate, citrate, or antacids for conditions such as stomach acid reflux\u2014known as heartburn. Cushing\u2019s disease, which is the chronic hypersecretion of adrenocorticotropic hormone (ACTH) by the anterior pituitary gland, can cause chronic metabolic alkalosis. The over secretion of ACTH results in elevated aldosterone levels and an increased loss of potassium by urinary excretion. Other causes of metabolic alkalosis include the loss of hydrochloric acid from the stomach through vomiting, potassium depletion due to the use of diuretics for hypertension, and the excessive use of laxatives.<\/p>\r\n\r\n<\/section><section id=\"fs-id2020926\" data-depth=\"1\">\r\n<h2 data-type=\"title\">Respiratory Acidosis: Primary Carbonic Acid\/CO<sub>2<\/sub>\u00a0Excess<\/h2>\r\n<p id=\"fs-id1971541\"><span id=\"term-00003\" data-type=\"term\">Respiratory acidosis<\/span>\u00a0occurs when the blood is overly acidic due to an excess of carbonic acid, resulting from too much CO<sub>2<\/sub>\u00a0in the blood. Respiratory acidosis can result from anything that interferes with respiration, such as pneumonia, emphysema, or congestive heart failure.<\/p>\r\n\r\n<\/section><section id=\"fs-id1890565\" data-depth=\"1\">\r\n<h2 data-type=\"title\">Respiratory Alkalosis: Primary Carbonic Acid\/CO<sub>2\u00a0<\/sub>Deficiency<\/h2>\r\n<p id=\"fs-id2044528\"><span id=\"term-00004\" data-type=\"term\">Respiratory alkalosis<\/span>\u00a0occurs when the blood is overly alkaline due to a deficiency in carbonic acid and CO<sub>2<\/sub>\u00a0levels in the blood. This condition usually occurs when too much CO<sub>2<\/sub> is exhaled from the lungs, as occurs in hyperventilation, which is breathing that is deeper or more frequent than normal. An elevated respiratory rate leading to hyperventilation can be due to extreme emotional upset or fear, fever, infections, hypoxia, or abnormally high levels of catecholamines, such as epinephrine and norepinephrine. Surprisingly, aspirin overdose\u2014salicylate toxicity\u2014can result in respiratory alkalosis as the body tries to compensate for initial acidosis.<\/p>\r\n\r\n<\/section><section id=\"fs-id1952858\" data-depth=\"1\">\r\n<h2 data-type=\"title\">Compensation Mechanisms<\/h2>\r\n<p id=\"fs-id891846\">Various compensatory mechanisms exist to maintain blood pH within a narrow range, including buffers, respiration, and renal mechanisms. Although compensatory mechanisms usually work very well, when one of these mechanisms is not working properly (like kidney failure or respiratory disease), they have their limits. If the pH and bicarbonate to carbonic acid ratio are changed too drastically, the body may not be able to compensate. Moreover, extreme changes in pH can denature proteins. Extensive damage to proteins in this way can result in disruption of normal metabolic processes, serious tissue damage, and ultimately death.<\/p>\r\n\r\n<section id=\"fs-id2024835\" data-depth=\"2\">\r\n<h3 data-type=\"title\">Respiratory Compensation<\/h3>\r\n<p id=\"fs-id1842471\">Respiratory compensation for metabolic acidosis increases the respiratory rate to drive off CO<sub>2<\/sub>\u00a0and readjust the bicarbonate to carbonic acid ratio to the 20:1 level. This adjustment can occur within minutes. Respiratory compensation for metabolic alkalosis is not as adept as its compensation for acidosis. The normal response of the respiratory system to elevated pH is to increase the amount of CO<sub>2<\/sub>\u00a0in the blood by decreasing the respiratory rate to conserve CO<sub>2<\/sub>. There is a limit to the decrease in respiration, however, that the body can tolerate. Hence, the respiratory route is less efficient at compensating for metabolic alkalosis than for acidosis.<\/p>\r\n\r\n<\/section><section id=\"fs-id1375885\" data-depth=\"2\">\r\n<h3 data-type=\"title\">Metabolic Compensation<\/h3>\r\n<p id=\"fs-id1906730\">Metabolic and renal compensation for respiratory diseases that can create acidosis revolves around the conservation of bicarbonate ions. In cases of respiratory acidosis, the kidney increases the conservation of bicarbonate and secretion of H<sup>+<\/sup>\u00a0through the exchange mechanism discussed earlier. These processes increase the concentration of bicarbonate in the blood, reestablishing the proper relative concentrations of bicarbonate and carbonic acid. In cases of respiratory alkalosis, the kidneys decrease the production of bicarbonate and reabsorb H<sup>+\u00a0<\/sup>from the tubular fluid. These processes can be limited by the exchange of potassium by the renal cells, which use a K<sup>+<\/sup>-H<sup>+<\/sup>\u00a0exchange mechanism (antiporter).<\/p>\r\n\r\n<header>\r\n<h3 class=\"os-title\" data-type=\"title\"><span class=\"os-title-label\">Interactive Link<\/span><\/h3>\r\n<\/header><section>\r\n<div class=\"os-note-body\">\r\n<p id=\"fs-id1765737\">Watch this\u00a0<a href=\"http:\/\/openstax.org\/l\/altitude\" target=\"_blank\" rel=\"noopener nofollow\">video<\/a>\u00a0to see a demonstration of the effect altitude has on blood pH. What effect does high altitude have on blood pH, and why?<\/p>\r\n\r\n<\/div>\r\n<\/section><\/section><section id=\"fs-id1385227\" data-depth=\"2\">\r\n<h1>Adaption<\/h1>\r\n<p style=\"text-align: start\">This chapter was adapted by Carter Allen from the following text:<\/p>\r\n<p style=\"text-align: start\"><a href=\"https:\/\/openstax.org\/books\/anatomy-and-physiology-2e\/pages\/26-5-disorders-of-acid-base-balance\" target=\"_blank\" rel=\"noopener\">Disorders Acid Base Balance<\/a>\u00a0<strong>in\u00a0<\/strong><a href=\"https:\/\/openstax.org\/books\/anatomy-and-physiology\/\">Anatomy and Physiology<\/a>\u00a0by\u00a0OSCRiceUniversity\u00a0is licensed under a\u00a0<a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">Creative Commons Attribution 4.0 International License<\/a><\/p>\r\n\r\n<\/section><\/section>","rendered":"<div class=\"textbox textbox--learning-objectives\">\n<header class=\"textbox__header\">\n<p class=\"textbox__title\">Learning Objectives<\/p>\n<\/header>\n<div class=\"textbox__content\">\n<p>By the end of this section, you will be able to:<\/p>\n<ul>\n<li>Identify the three blood variables considered when making a diagnosis of acidosis or alkalosis.<\/li>\n<li>Identify the source of compensation for blood pH problems of a respiratory origin.<\/li>\n<li>Identify the source of compensation for blood pH problems of a metabolic or renal origin.<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<p id=\"fs-id1615929\">Normal arterial blood pH is restricted to a very narrow range of 7.35 to 7.45. A person who has a blood pH below 7.35 is considered to be in acidosis (actually, \u201cphysiological acidosis,\u201d because blood is not truly acidic until its pH drops below 7), and a continuous blood pH below 7.0 can be fatal. Acidosis has several symptoms, including headache and confusion, and the individual can become lethargic and easily fatigued (<a class=\"autogenerated-content\" href=\"#AcidosisAlkalosisSymptoms\">Symptoms of Acidosis and Alkalosis<\/a>). A person who has a blood pH above 7.45 is considered to be in alkalosis, and a pH above 7.8 is fatal. Some symptoms of alkalosis include cognitive impairment (which can progress to unconsciousness), tingling or numbness in the extremities, muscle twitching and spasm, and nausea and vomiting. Both acidosis and alkalosis can be caused by either metabolic or respiratory disorders.<\/p>\n<p id=\"fs-id1416028\">As discussed earlier in this chapter, the concentration of carbonic acid in the blood is dependent on the level of CO<sub>2<\/sub>\u00a0in the body and the amount of CO<sub>2<\/sub>\u00a0gas exhaled through the lungs. Thus, the respiratory contribution to acid-base balance is usually discussed in terms of CO<sub>2<\/sub>\u00a0(rather than of carbonic acid). Remember that a molecule of carbonic acid is lost for every molecule of CO<sub>2<\/sub>\u00a0exhaled, and a molecule of carbonic acid is formed for every molecule of CO<sub>2<\/sub> retained.<\/p>\n<figure id=\"attachment_9614\" aria-describedby=\"caption-attachment-9614\" style=\"width: 680px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-9614\" src=\"https:\/\/pressbooks.bccampus.ca\/pathology\/wp-content\/uploads\/sites\/1260\/2025\/08\/2716_Symptoms_of_Acidosis_Alkalosis.jpg\" alt=\"This figure points out the symptoms of acidosis and alkalosis on a silhouette of a human torso. The effects of acidosis on the central nervous system include headache, sleepiness, confusion, loss of consciousness and coma. The effects of acidosis are given on the left side of the diagram. The effects of acidosis on the respiratory system include shortness of breath and coughing. The effects of acidosis on the heart include arrhythmia and increased heart rate. The effects of acidosis on the muscular system include seizures and weakness. The effects of acidosis on the digestive system include nausea, vomiting and diarrhea. The right side of the diagram describes the symptoms of alkalosis. The effects of alkalosis on the central nervous system include confusion, light-headedness, stupor, and coma. The effects of alkalosis on the peripheral nervous system include hand tremor and numbness or tingling in the face, hands, and feet. The effects of alkalosis on the muscular system include twitching and prolonged spasms. The effects of alkalosis on the digestive system include nausea and vomiting.\" width=\"680\" height=\"441\" srcset=\"https:\/\/pressbooks.bccampus.ca\/pathology\/wp-content\/uploads\/sites\/1260\/2025\/08\/2716_Symptoms_of_Acidosis_Alkalosis.jpg 860w, https:\/\/pressbooks.bccampus.ca\/pathology\/wp-content\/uploads\/sites\/1260\/2025\/08\/2716_Symptoms_of_Acidosis_Alkalosis-300x195.jpg 300w, https:\/\/pressbooks.bccampus.ca\/pathology\/wp-content\/uploads\/sites\/1260\/2025\/08\/2716_Symptoms_of_Acidosis_Alkalosis-768x498.jpg 768w, https:\/\/pressbooks.bccampus.ca\/pathology\/wp-content\/uploads\/sites\/1260\/2025\/08\/2716_Symptoms_of_Acidosis_Alkalosis-65x42.jpg 65w, https:\/\/pressbooks.bccampus.ca\/pathology\/wp-content\/uploads\/sites\/1260\/2025\/08\/2716_Symptoms_of_Acidosis_Alkalosis-225x146.jpg 225w, https:\/\/pressbooks.bccampus.ca\/pathology\/wp-content\/uploads\/sites\/1260\/2025\/08\/2716_Symptoms_of_Acidosis_Alkalosis-350x227.jpg 350w\" sizes=\"auto, (max-width: 680px) 100vw, 680px\" \/><figcaption id=\"caption-attachment-9614\" class=\"wp-caption-text\"><strong>Symptoms of Acidosis and Alkalosis<\/strong> &#8211; Symptoms of acidosis affect several organ systems. Both acidosis and alkalosis can be diagnosed using a blood test.<\/figcaption><\/figure>\n<h2 data-type=\"title\">Metabolic Acidosis: Primary Bicarbonate Deficiency<\/h2>\n<p><span id=\"term-00001\" data-type=\"term\">Metabolic acidosis<\/span>\u00a0occurs when the blood is too acidic (pH below 7.35) due to too little bicarbonate, a condition called primary bicarbonate deficiency. At the normal pH of 7.40, the ratio of bicarbonate to carbonic acid buffer is 20:1. If a person\u2019s blood pH drops below 7.35, then the person is in metabolic acidosis. The most common cause of metabolic acidosis is the presence of organic acids or excessive ketone bodies in the blood.\u00a0The table below\u00a0lists some other causes of metabolic acidosis.<\/p>\n<div class=\"os-table os-top-titled-container\">\n<div class=\"os-table-title\" style=\"text-align: center\"><strong>Common Causes of Metabolic Acidosis and Blood Metabolites<\/strong><\/div>\n<table id=\"tbl-ch27_02\" class=\"top-titled aligncenter\" style=\"width: 490px;height: 166px\">\n<thead>\n<tr style=\"height: 15px\">\n<th style=\"width: 150.938px;height: 15px\" scope=\"col\">Cause<\/th>\n<th style=\"width: 310.188px;height: 15px\" scope=\"col\">Metabolite<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"height: 15px\">\n<td style=\"width: 151.438px;height: 15px\">Diarrhea<\/td>\n<td style=\"width: 310.688px;height: 15px\">Bicarbonate<\/td>\n<\/tr>\n<tr style=\"height: 15px\">\n<td style=\"width: 151.438px;height: 15px\">Uremia<\/td>\n<td style=\"width: 310.688px;height: 15px\">Phosphoric, sulfuric, and lactic acids<\/td>\n<\/tr>\n<tr style=\"height: 15px\">\n<td style=\"width: 151.438px;height: 15px\">Diabetic ketoacidosis<\/td>\n<td style=\"width: 310.688px;height: 15px\">Increased ketone bodies<\/td>\n<\/tr>\n<tr style=\"height: 15px\">\n<td style=\"width: 151.438px;height: 15px\">Strenuous exercise<\/td>\n<td style=\"width: 310.688px;height: 15px\">Lactic acid<\/td>\n<\/tr>\n<tr style=\"height: 15px\">\n<td style=\"width: 151.438px;height: 15px\">Methanol<\/td>\n<td style=\"width: 310.688px;height: 15px\">Formic acid*<\/td>\n<\/tr>\n<tr style=\"height: 15px\">\n<td style=\"width: 151.438px;height: 15px\">Paraldehyde<\/td>\n<td style=\"width: 310.688px;height: 15px\">\u03b2-Hydroxybutyric acid*<\/td>\n<\/tr>\n<tr style=\"height: 15px\">\n<td style=\"width: 151.438px;height: 15px\">Isopropanol<\/td>\n<td style=\"width: 310.688px;height: 15px\">Propionic acid*<\/td>\n<\/tr>\n<tr style=\"height: 31px\">\n<td style=\"width: 151.438px;height: 31px\">Ethylene glycol<\/td>\n<td style=\"width: 310.688px;height: 31px\">Glycolic acid, and some oxalic and formic acids*<\/td>\n<\/tr>\n<tr style=\"height: 15px\">\n<td style=\"width: 151.438px;height: 15px\">Salicylate\/aspirin<\/td>\n<td style=\"width: 310.688px;height: 15px\">Sulfasalicylic acid (SSA)*<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<div class=\"os-caption-container\" style=\"text-align: center\">\u00a0<span class=\"os-caption\">*Acid metabolites from ingested chemical.<\/span><\/div>\n<\/div>\n<p>The first three of the eight causes of metabolic acidosis listed are medical (or unusual physiological) conditions. Strenuous exercise can cause temporary metabolic acidosis due to the production of lactic acid. The last five causes result from the ingestion of specific substances. The active form of aspirin is its metabolite, sulfasalicylic acid. An overdose of aspirin causes acidosis due to the acidity of this metabolite. Metabolic acidosis can also result from uremia, which is the retention of urea and uric acid. Metabolic acidosis can also arise from diabetic ketoacidosis, wherein an excess of ketone bodies are present in the blood. Other causes of metabolic acidosis are a decrease in the excretion of hydrogen ions, which inhibits the conservation of bicarbonate ions, and excessive loss of bicarbonate ions through the gastrointestinal tract due to diarrhea.<\/p>\n<section id=\"fs-id1247876\" data-depth=\"1\">\n<h2 data-type=\"title\">Metabolic Alkalosis: Primary Bicarbonate Excess<\/h2>\n<p id=\"fs-id1721352\"><span id=\"term-00002\" data-type=\"term\">Metabolic alkalosis<\/span>\u00a0is the opposite of metabolic acidosis. It occurs when the blood is too alkaline (pH above 7.45) due to too much bicarbonate (called primary bicarbonate excess).<\/p>\n<p id=\"fs-id1249408\">A transient excess of bicarbonate in the blood can follow ingestion of excessive amounts of bicarbonate, citrate, or antacids for conditions such as stomach acid reflux\u2014known as heartburn. Cushing\u2019s disease, which is the chronic hypersecretion of adrenocorticotropic hormone (ACTH) by the anterior pituitary gland, can cause chronic metabolic alkalosis. The over secretion of ACTH results in elevated aldosterone levels and an increased loss of potassium by urinary excretion. Other causes of metabolic alkalosis include the loss of hydrochloric acid from the stomach through vomiting, potassium depletion due to the use of diuretics for hypertension, and the excessive use of laxatives.<\/p>\n<\/section>\n<section id=\"fs-id2020926\" data-depth=\"1\">\n<h2 data-type=\"title\">Respiratory Acidosis: Primary Carbonic Acid\/CO<sub>2<\/sub>\u00a0Excess<\/h2>\n<p id=\"fs-id1971541\"><span id=\"term-00003\" data-type=\"term\">Respiratory acidosis<\/span>\u00a0occurs when the blood is overly acidic due to an excess of carbonic acid, resulting from too much CO<sub>2<\/sub>\u00a0in the blood. Respiratory acidosis can result from anything that interferes with respiration, such as pneumonia, emphysema, or congestive heart failure.<\/p>\n<\/section>\n<section id=\"fs-id1890565\" data-depth=\"1\">\n<h2 data-type=\"title\">Respiratory Alkalosis: Primary Carbonic Acid\/CO<sub>2\u00a0<\/sub>Deficiency<\/h2>\n<p id=\"fs-id2044528\"><span id=\"term-00004\" data-type=\"term\">Respiratory alkalosis<\/span>\u00a0occurs when the blood is overly alkaline due to a deficiency in carbonic acid and CO<sub>2<\/sub>\u00a0levels in the blood. This condition usually occurs when too much CO<sub>2<\/sub> is exhaled from the lungs, as occurs in hyperventilation, which is breathing that is deeper or more frequent than normal. An elevated respiratory rate leading to hyperventilation can be due to extreme emotional upset or fear, fever, infections, hypoxia, or abnormally high levels of catecholamines, such as epinephrine and norepinephrine. Surprisingly, aspirin overdose\u2014salicylate toxicity\u2014can result in respiratory alkalosis as the body tries to compensate for initial acidosis.<\/p>\n<\/section>\n<section id=\"fs-id1952858\" data-depth=\"1\">\n<h2 data-type=\"title\">Compensation Mechanisms<\/h2>\n<p id=\"fs-id891846\">Various compensatory mechanisms exist to maintain blood pH within a narrow range, including buffers, respiration, and renal mechanisms. Although compensatory mechanisms usually work very well, when one of these mechanisms is not working properly (like kidney failure or respiratory disease), they have their limits. If the pH and bicarbonate to carbonic acid ratio are changed too drastically, the body may not be able to compensate. Moreover, extreme changes in pH can denature proteins. Extensive damage to proteins in this way can result in disruption of normal metabolic processes, serious tissue damage, and ultimately death.<\/p>\n<section id=\"fs-id2024835\" data-depth=\"2\">\n<h3 data-type=\"title\">Respiratory Compensation<\/h3>\n<p id=\"fs-id1842471\">Respiratory compensation for metabolic acidosis increases the respiratory rate to drive off CO<sub>2<\/sub>\u00a0and readjust the bicarbonate to carbonic acid ratio to the 20:1 level. This adjustment can occur within minutes. Respiratory compensation for metabolic alkalosis is not as adept as its compensation for acidosis. The normal response of the respiratory system to elevated pH is to increase the amount of CO<sub>2<\/sub>\u00a0in the blood by decreasing the respiratory rate to conserve CO<sub>2<\/sub>. There is a limit to the decrease in respiration, however, that the body can tolerate. Hence, the respiratory route is less efficient at compensating for metabolic alkalosis than for acidosis.<\/p>\n<\/section>\n<section id=\"fs-id1375885\" data-depth=\"2\">\n<h3 data-type=\"title\">Metabolic Compensation<\/h3>\n<p id=\"fs-id1906730\">Metabolic and renal compensation for respiratory diseases that can create acidosis revolves around the conservation of bicarbonate ions. In cases of respiratory acidosis, the kidney increases the conservation of bicarbonate and secretion of H<sup>+<\/sup>\u00a0through the exchange mechanism discussed earlier. These processes increase the concentration of bicarbonate in the blood, reestablishing the proper relative concentrations of bicarbonate and carbonic acid. In cases of respiratory alkalosis, the kidneys decrease the production of bicarbonate and reabsorb H<sup>+\u00a0<\/sup>from the tubular fluid. These processes can be limited by the exchange of potassium by the renal cells, which use a K<sup>+<\/sup>-H<sup>+<\/sup>\u00a0exchange mechanism (antiporter).<\/p>\n<header>\n<h3 class=\"os-title\" data-type=\"title\"><span class=\"os-title-label\">Interactive Link<\/span><\/h3>\n<\/header>\n<section>\n<div class=\"os-note-body\">\n<p id=\"fs-id1765737\">Watch this\u00a0<a href=\"http:\/\/openstax.org\/l\/altitude\" target=\"_blank\" rel=\"noopener nofollow\">video<\/a>\u00a0to see a demonstration of the effect altitude has on blood pH. What effect does high altitude have on blood pH, and why?<\/p>\n<\/div>\n<\/section>\n<\/section>\n<section id=\"fs-id1385227\" data-depth=\"2\">\n<h1>Adaption<\/h1>\n<p style=\"text-align: start\">This chapter was adapted by Carter Allen from the following text:<\/p>\n<p style=\"text-align: start\"><a href=\"https:\/\/openstax.org\/books\/anatomy-and-physiology-2e\/pages\/26-5-disorders-of-acid-base-balance\" target=\"_blank\" rel=\"noopener\">Disorders Acid Base Balance<\/a>\u00a0<strong>in\u00a0<\/strong><a href=\"https:\/\/openstax.org\/books\/anatomy-and-physiology\/\">Anatomy and Physiology<\/a>\u00a0by\u00a0OSCRiceUniversity\u00a0is licensed under a\u00a0<a href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">Creative Commons Attribution 4.0 International License<\/a><\/p>\n<\/section>\n<\/section>\n<div class=\"media-attributions clear\" prefix:cc=\"http:\/\/creativecommons.org\/ns#\" prefix:dc=\"http:\/\/purl.org\/dc\/terms\/\"><h2>Media Attributions<\/h2><ul><li about=\"https:\/\/openstax.org\/books\/anatomy-and-physiology-2e\/pages\/26-5-disorders-of-acid-base-balance\"><a rel=\"cc:attributionURL\" href=\"https:\/\/openstax.org\/books\/anatomy-and-physiology-2e\/pages\/26-5-disorders-of-acid-base-balance\" property=\"dc:title\">2716_Symptoms_of_Acidosis_Alkalosis<\/a>  &copy;  OSCRiceUniversity    is licensed under a  <a rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY (Attribution)<\/a> license<\/li><\/ul><\/div>","protected":false},"author":1076,"menu_order":5,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":["j-gordon-betts-xthrkeeivi-8fx5ggejmj","kelly-a-young-2saui1agja-8pwwlj8hsz","james-a-wise","eddie-johnson-p3ptqqn1w8-nrmqg92z00","brandon-poe-pdu6v9qtf4-aui3anrqi5","dean-h-kruse-zvxpwgxnv6-fizzxxfhei","oksana-korol-vdj3pn6oya-rsjsmfezpo","jody-e-johnson-povh9ndei8-b4kbn6l6pj","mark-womble-9aswiv74hr","peter-desaix-s9tknjd6au"],"pb_section_license":""},"chapter-type":[],"contributor":[257,271,295,314,68,359,370,138,454,461],"license":[],"class_list":["post-7694","chapter","type-chapter","status-publish","hentry","contributor-brandon-poe-pdu6v9qtf4-aui3anrqi5","contributor-dean-h-kruse-zvxpwgxnv6-fizzxxfhei","contributor-eddie-johnson-p3ptqqn1w8-nrmqg92z00","contributor-j-gordon-betts-xthrkeeivi-8fx5ggejmj","contributor-james-a-wise","contributor-jody-e-johnson-povh9ndei8-b4kbn6l6pj","contributor-kelly-a-young-2saui1agja-8pwwlj8hsz","contributor-mark-womble-9aswiv74hr","contributor-oksana-korol-vdj3pn6oya-rsjsmfezpo","contributor-peter-desaix-s9tknjd6au"],"part":7690,"_links":{"self":[{"href":"https:\/\/pressbooks.bccampus.ca\/pathology\/wp-json\/pressbooks\/v2\/chapters\/7694","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.bccampus.ca\/pathology\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.bccampus.ca\/pathology\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/pathology\/wp-json\/wp\/v2\/users\/1076"}],"version-history":[{"count":7,"href":"https:\/\/pressbooks.bccampus.ca\/pathology\/wp-json\/pressbooks\/v2\/chapters\/7694\/revisions"}],"predecessor-version":[{"id":9806,"href":"https:\/\/pressbooks.bccampus.ca\/pathology\/wp-json\/pressbooks\/v2\/chapters\/7694\/revisions\/9806"}],"part":[{"href":"https:\/\/pressbooks.bccampus.ca\/pathology\/wp-json\/pressbooks\/v2\/parts\/7690"}],"metadata":[{"href":"https:\/\/pressbooks.bccampus.ca\/pathology\/wp-json\/pressbooks\/v2\/chapters\/7694\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.bccampus.ca\/pathology\/wp-json\/wp\/v2\/media?parent=7694"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/pathology\/wp-json\/pressbooks\/v2\/chapter-type?post=7694"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/pathology\/wp-json\/wp\/v2\/contributor?post=7694"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/pathology\/wp-json\/wp\/v2\/license?post=7694"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}