Säure-Base-Störungen

An acid-base disorder means the blood has become too acidic (acidosis) or too alkaline (alkalosis). Your lungs and kidneys normally keep blood pH within a very narrow range, the lungs by breathing off carbon dioxide and the kidneys by excreting acid and conserving bicarbonate.

It is not a disease in itself but a sign that something else is wrong, such as kidney failure, uncontrolled diabetes, severe diarrhoea, vomiting or lung disease. Treatment is aimed at that cause.

Symptome

• Fast, deep breathing in metabolic acidosis
• Tiredness, weakness and poor appetite
• Nausea or vomiting
• Confusion or drowsiness when severe
• Muscle cramps, twitching or tingling in alkalosis
• Palpitations, because potassium often shifts at the same time
• Often no symptoms at all in mild chronic forms found on a blood test

Ursachen und Risikofaktoren

Metabolic acidosis arises when the body makes too much acid (diabetic ketoacidosis, lactic acidosis from shock or sepsis, some poisonings), loses bicarbonate (prolonged diarrhoea, renal tubular acidosis) or cannot excrete acid (chronic kidney disease). Metabolic alkalosis usually follows vomiting, diuretic tablets or hormone excess. Respiratory acidosis comes from under-breathing, as in severe COPD or sedative overdose, and respiratory alkalosis from over-breathing due to anxiety, pain, pregnancy or altitude.

Wie es diagnostiziert wird

• Blood gas analysis: A small arterial or venous sample gives pH, carbon dioxide and bicarbonate within minutes and shows which type of disturbance is present.
• Electrolytes and anion gap: Sodium, chloride and bicarbonate are used to calculate the anion gap, which narrows the list of causes of acidosis.
• Kidney function, glucose, lactate and ketones: These identify kidney failure, diabetic ketoacidosis or poor tissue oxygen supply.
• Urine pH and electrolytes: Help to separate kidney causes, such as renal tubular acidosis, from gut losses.

Behandlungsmöglichkeiten

• Treating the cause: Insulin and fluids for ketoacidosis, antibiotics and circulation support for sepsis, stopping an offending drug, or breathing support for respiratory failure.
• Oral sodium bicarbonate: Used long term in chronic kidney disease when bicarbonate stays low, because correcting it may protect bone, muscle and kidney function.
• Intravenous fluids and potassium: Saline and potassium chloride correct most alkalosis caused by vomiting or diuretics.
• Dialysis: Removes acid rapidly in severe kidney failure or certain poisonings such as methanol or ethylene glycol.

Wenn es dringend ist

Rapid or laboured breathing, new confusion, drowsiness, persistent vomiting, or feeling very unwell with diabetes and high sugars need same-day emergency assessment where you are. Severe acidosis can be life-threatening within hours and must never wait for a trip.

Reisen nach Türkiye zur Behandlung

Acute acid-base problems are emergencies and are treated in the nearest hospital. Travel only makes sense for a stable, chronic problem, for example a planned nephrology work-up of persistently low bicarbonate or suspected renal tubular acidosis, or a second opinion on chronic kidney disease. Ongoing bicarbonate treatment and blood monitoring then belong with your doctor at home.

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