Complications of Acidosis
Acidosis causes significant complications affecting multiple organ systems, including cardiovascular collapse, respiratory dysfunction, neurological impairment, and electrolyte abnormalities, all of which contribute to increased morbidity and mortality if not promptly addressed. 1
Cardiovascular Complications
- Decreased cardiac output and contractility - Acidosis reduces myocardial contractility and cardiac output
- Arterial vasodilation with hypotension - Particularly severe in pH <7.2 2
- Increased risk of arrhythmias - Acidosis predisposes to various cardiac rhythm disturbances
- Decreased responsiveness to vasopressors - Making shock more difficult to treat
- Impaired tissue perfusion - Contributing to organ dysfunction
Neurological Complications
- Altered mental status - Ranging from confusion to coma
- Cerebral edema - Particularly in diabetic ketoacidosis when treated too rapidly 1
- Increased intracranial pressure - Can occur with severe acidosis
- Seizures - May develop in profound acidosis
Respiratory Complications
- Hyperventilation - Compensatory mechanism that may lead to respiratory muscle fatigue
- Respiratory failure - May develop as compensation mechanisms fail
- Pulmonary edema - Can complicate treatment of diabetic ketoacidosis 1
- Hypoxemia - Due to reduced lung compliance and increased lung water content 1
Metabolic and Electrolyte Complications
- Hypokalemia - During treatment as potassium shifts back into cells 1
- Hyperkalemia - Initially as acidosis causes potassium to shift out of cells
- Impaired glucose metabolism - Insulin resistance and hyperglycemia
- Increased protein catabolism - Leading to muscle wasting in chronic acidosis 3
- Abnormal bone metabolism - With chronic acidosis causing bone demineralization 3
Immune System Complications
- Suppressed immune response - Increasing susceptibility to infections 2
- Enhanced inflammatory response - Contributing to organ damage 2
Renal Complications
- Impaired renal function - Acidosis can worsen existing kidney disease
- Increased ammonia production - As compensation mechanism
- Nephrolithiasis - In chronic metabolic acidosis
Hematologic Complications
- Impaired oxygen delivery to tissues - Due to shift in the oxygen-hemoglobin dissociation curve
- Decreased ATP production - Affecting cellular energy metabolism 2
- Hemolytic reactions - In severe acidosis
Clinical Management Considerations
- Severity of complications correlates with the degree and rapidity of pH decline
- Treatment should address the underlying cause while supporting organ function
- Sodium bicarbonate therapy is indicated in severe metabolic acidosis (pH <7.1) but remains controversial in less severe cases 4
- In diabetic ketoacidosis, careful correction of acidosis is essential to prevent cerebral edema 1
- Controlled oxygen therapy targeting saturation of 88-92% is recommended in respiratory acidosis to prevent worsening hypercapnia 1
The approach to acidosis must be systematic, addressing both the primary cause and the resulting physiological derangements. Mortality increases significantly with severe acidosis (pH <7.2), making prompt recognition and treatment essential for improving outcomes.