Does acidosis impair organ functioning?

From the Guidelines

Acidosis significantly impairs organ functioning, leading to disruptions in various physiological processes, including enzyme function, cellular metabolism, and organ system operations. The condition of acidosis, characterized by an excess of acid in the body fluids, causes the pH to fall below 7.35, affecting multiple organ systems. In the context of chronic renal failure, acidosis is associated with increased oxidation of branched chain amino acids, increased protein degradation, and decreased albumin synthesis, as noted in the clinical practice guidelines for nutrition in chronic renal failure by the National Kidney Foundation 1. Key points to consider include:

• Acidosis disrupts normal cellular processes and impairs potassium regulation, potentially causing hyperkalemia.
• Severe acidosis can lead to decreased cardiac contractility, arrhythmias, and vasodilation, resulting in hypotension.
• Neurologically, acidosis may cause confusion, lethargy, and in extreme cases, coma.
• Respiratory function is affected through increased respiratory rate as the body attempts to eliminate excess carbon dioxide.
• Correction of acidemia due to metabolic acidosis has been associated with increased serum albumin, decreased protein degradation rates, and increased plasma concentrations of branched chain amino acids, as reported in the study by the National Kidney Foundation 1. Therefore, managing acidosis is crucial to prevent these complications, and treatment should focus on addressing the underlying cause and normalizing pH, with sodium bicarbonate administration considered in severe cases. It is essential to monitor serum bicarbonate levels regularly and maintain them at or above 22 mmol/L to prevent the adverse effects of acidosis, as recommended by the National Kidney Foundation 1.

From the FDA Drug Label

In cardiac arrest, however, the risks from acidosis exceed those of hypernatremia. In metabolic acidosis associated with shock, therapy should be monitored by measuring blood gases, plasma osmolarity, arterial blood lactate, hemodynamics and cardiac rhythm. Treatment of metabolic acidosis should, if possible, be superimposed on measures designed to control the basic cause of the acidosis - e.g., insulin in uncomplicated diabetes, blood volume restoration in shock.

Acidosis Impairs Organ Functioning:

• The drug labels suggest that acidosis is associated with severe conditions such as cardiac arrest and shock, which can impair organ functioning.
• The labels also indicate that acidosis can lead to hemodynamic and cardiac rhythm disturbances, which can further impair organ functioning.
• Therefore, it can be inferred that acidosis does impair organ functioning, particularly in severe cases such as cardiac arrest and shock 2, 2.

From the Research

Organ Functioning and Acidosis

• Metabolic acidosis can impair organ functioning, particularly in the bones and muscles, by inducing abnormalities in hormone release and function, including growth hormone, insulin, and parathyroid hormone 3.
• The disorder can also lead to impaired growth in infants and children, and loss of bone and muscle mass in adults, which can be corrected by treating acidosis with NaHCO3 3.
• In patients with chronic kidney disease, metabolic acidosis can cause abnormalities in bone and muscle metabolism, which can be directly linked to the presence of acidosis and can be largely corrected by treating acidosis with NaHCO3 3, 4.

Effects on Specific Organs

• Metabolic acidosis can affect the kidneys by impairing their ability to maintain acid-base homeostasis, leading to acid accumulation and various complications such as impairment in nutritional status and worsened uremic bone disease 5.
• The heart can also be affected, with acute metabolic acidosis leading to decreased cardiac output, arterial dilatation with hypotension, and altered oxygen delivery 6.
• Additionally, metabolic acidosis can impair the immune response and predispose to arrhythmias 6.

Treatment and Management

• Treatment of metabolic acidosis with alkali administration, such as NaHCO3, can help to correct the disorder and improve cellular function, particularly in patients with chronic kidney disease 3, 5.
• However, the use of alkalinizing agents in the treatment of metabolic acidosis remains controversial, except in certain cases such as hyperkalemia and certain drug or toxin ingestions 7.