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Acidosis and Alkalosis

This article was last modified on
January 28, 2022

What are Acidosis and Alkalosis?

Acidosis and alkalosis are conditions in which there is a disturbance in the pH balance (acid-base balance) of the body. Acidosis is a condition in
which the bodily fluids become too acidic, with an abnormally low pH level. In alkalosis, the opposite is true: the fluids of the body are too
alkaline (high in pH).

Acid-Base Balance in the Body

pH is a way of measuring the acidity or alkalinity of a fluid, on a scale from 1 to 14. A pH of 7 is considered neutral, while 1 is extremely acidic,
and 14 is extremely alkaline, which is sometimes called “basic”. Normally, the pH of the human body is around 7.4, which is slightly higher than
the chemically-neutral pH of 7. This slightly alkaline pH is ideal for many crucial processes that take place continually in the human body.
For instance, normal pH and proper acid-base balance enables the right amount of oxygen to enter and circulate in the blood, moving oxygen to
all the cells and tissues of the body. Proteins, including enzymes, which speed up many chemical actions in the body, can’t function normally if
body fluids are too acidic.

Acidosis
Acidosis occurs when bodily fluids contain too much acid. This results in a decrease in blood pH, since lower numbers represent more acidic
substances. The blood is considered to be abnormally acidic (high in acid) when its pH is lower than 7.35.

Mild acidosis may be present without causing symptoms. In some cases, especially in seriously ill people, it can worsen if it is not diagnosed and
treated. Acidosis can sometimes lead to serious physical effects, such a:

Hyperventilation (breathing abnormally fast or deeply)

Impaired heart function
Low blood pressure
Coma

Alkalosis
Alkalosis is a condition in which the blood has too little acid, making it too alkaline or basic, which is another term for alkaline. This results in a
higher blood pH, as higher numbers represent more alkaline substances. The blood is considered to be abnormally alkaline when its pH is
above 7.45.

Mild, longstanding (chronic) alkalosis may occur without noticeable symptoms. Alkalosis that causes severe or rapid pH changes is more likely
to cause symptoms that can include:

Dizziness or lightheadedness
Numbness of the hands and feet
Confusion
Nausea or vomiting
 Muscle twitching or spasms
Low levels of oxygen in the blood
Seizures
Losing consciousness or being nearly unconscious

Staying in Balance
The normal pH of the human body ranges from 7.35 to 7.45, with 7.4 being average.

The body constantly engages in a number of activities to maintain pH within this narrow range. Under normal circumstances, the level of acids
and bases in the body may rise and fall, as more acids and bases are produced or taken in. Processes in the body are always at work to adjust
for these changes and keep the acid-base balance within the normal range.

Acid Buildup
Our bodies constantly produce acids during the normal processes of metabolism. Metabolism means all of the chemical and physical processes
that our bodies use to generate energy and to produce substances necessary to maintain life. For example, our bodies convert nutrients in our
food like fats, carbohydrates, and proteins into energy. The processes of metabolism normally generate large quantities of acids during these
ongoing activities.

Most of the acid in our bodies is carbonic acid. The metabolism of fats and carbohydrates generates carbon dioxide which combines with water
in the body to form carbonic acid. Other acids produced by the body include:

Lactic acid: This acid is mainly produced in muscle cells and red blood cells when the body metabolizes carbohydrates and oxygen levels
are low, such as during intense exercise.
Ketoacids or ketones: These acids are formed by the breakdown of fats when the body’s main source of energy, glucose (sugar), is in short
supply or when there is a lack of insulin, which is necessary for using glucose for energy.
Neutralizing and Removing Acids
Specialized cells in the brain and blood vessels sense the body’s acidity, and control processes that neutralize and remove acids. This feedback
loop is essential to maintaining the body’s acid-base balance. Maintaining balance is crucial because even small changes can severely affect
many organs and disrupt the way the cells of the body function.

The different mechanisms that the body uses to continually neutralize and remove acids and maintain pH balance include:

Breathing out carbon dioxide, which reduces acid in the body

Release of acid in urine
Regulating body pH through chemical buffering. Circulating weak acids and weak bases in the blood guard against abrupt changes in acidity
and alkalinity.

How the Body Maintains Acid-Base Balance

The body automatically adjusts when it notices an imbalance in pH. The mechanisms it uses push the acid-base balance back toward the ideal
pH range. The main organs involved in these processes are the lungs and the kidneys.

Lung Functions that Correct Imbalances

The lungs respiratory system responds to changes in acid-base balance caused by the body’s metabolic processes. Carbon dioxide, when
combined with water, forms an acid (carbonic acid).   When you breathe out, carbon dioxide is removed from your body into the environment and
your body removes acids that have been produced by metabolism. Your respiratory system automatically adjusts your breathing rate and the
amount of air that moves out of the lungs. This ensures you exhale the right amount of carbon dioxide based on how much acid your tissues are
producing.
For example, in diabetic ketoacidosis, low levels of insulin force the body to break down fats for energy use, in place of using glucose that
requires insulin.  Breakdown of fat produces excess ketoacids, which lower the body’s pH. The breathing rate increases to get rid of carbon
dioxide. When carbon dioxide is removed from the body at a faster rate, the level of acid in the body drops, and the pH starts to return toward
the normal range.

The lungs also can also adjust when blood pH is too high. For example, if someone loses stomach acid due to vomiting, the blood pH can rise. 
The breathing rate will slow and less carbon dioxide will be removed through breathing. This drives the body’s pH lower, toward the normal
range.

Kidney Functions that Correct Imbalances

Your kidneys also play a critical role in maintaining your body’s pH. Generally, the kidneys respond with acid-base imbalances from conditions
that affect the lungs.

The kidneys help maintain normal pH balance by increasing the amount of acid released in the urine when the body’s pH level is too low
(acidic), and retaining bicarbonate, which is a base (alkaline substance). This drives the pH higher toward the normal range.

Conversely, when the body’s pH is too high (alkaline), the kidneys increase the amount bicarbonate released in the urine, and retain acid to
lower the pH back toward the normal range.

The pH of urine shifts up or down as the kidneys adjust to blood acidity or alkalinity.

How Things Can Go Wrong

Although the body can generally maintain pH balance, some conditions can overwhelm the body’s ability to react to an imbalance. Acid-base
imbalances can also occur when lung or kidney disorders affect the ability of these organs to control for pH imbalances.

Metabolic vs Respiratory Acidosis and Alkalosis

Acidosis and alkalosis are categorized according to whether they are caused by metabolic (related to basic bodily processes) versus respiratory
(lung) problems. Understanding and determining the cause of the imbalance is important in helping to guide treatment of the pH imbalance.

The categories of acidosis are:

Metabolic acidosis: Metabolic acidosis occurs when too much acid is produced by the body, or too much bicarbonate, which is a base
(alkali), is lost. Also, taking in certain substances or poisons that are acidic or become acidic in the body can overwhelm the body’s
mechanisms and cause metabolic acidosis.
Respiratory acidosis: Respiratory acidosis occurs when lung or breathing disorders affect the body’s ability to breathe out carbon dioxide,
leading to too much acid in the body.

The categories of alkalosis are:

Metabolic alkalosis: Metabolic alkalosis may be caused by losing too much acid from the body, or by having too much bicarbonate.
Respiratory alkalosis: Respiratory alkalosis can happen when there is too little carbon dioxide in the blood due to the lungs breathing out
too much carbon dioxide. This may be due to hyperventilating, which is breathing abnormally fast, or conditions that cause shortness of
breath.

The following table summarizes how the body works to adjust for acid-base imbalances:

PH CONDITION THE BODY COMPENSATES BY:

Low Metabolic acidosis Breathing faster to exhale more CO2

High Metabolic alkalosis Breathing slower to exhale less CO2

Low Respiratory acidosis The kidneys retaining more bicarbonate and releasing more acid into urine

High Respiratory alkalosis The kidneys retaining more acid and releasing more bicarbonate into urine
Common causes of acidosis
The table below provides examples of common causes of acidosis:

COMMON CAUSES OF METABOLIC ACIDOSIS

Cause Examples of How Things Can Go Wrong

May occur when a substance that is acidic, or is metabolized to acid in the body, is swallowed, such as methanol or
Poisoning
antifreeze, or large amounts of aspirin

May occur when the body does not make enough insulin to metabolize sugar for energy. Instead, more fats and proteins
Ketoacidosis
are metabolized, which results in too many ketoacids for the body to process.

Alcoholic May occur with very heavy alcohol use and not eating enough food, which can lead to the body burning more fat than
Ketoacidosis usual.

Occurs when lactic acid builds up in the bloodstream. Severe illnesses can cause lactic acidosis when blood pressure is
Lactic
low and not enough oxygen gets to tissues. Examples of causes include sepsis due to a serious bacterial infection,
Acidosis
cancer and liver failure.

Kidney
Occurs when the kidneys are not functioning properly and are unable to remove enough acid to maintain normal pH. May
Failure/Kidney
also occur if kidney disease causes loss of bicarbonate, an alkaline substance that normally neutralizes acid in the body.
Disease
 Severe, May lead to loss of bicarbonate, which normally neutralizes acid in the body
Prolonged
Diarrhea

COMMON CAUSES OF RESPIRATORY ACIDOSIS

Cause Examples of How Things Can Go Wrong

May cause acid buildup in the body when breathing is impaired, and not enough carbon dioxide is exhaled. May be
Lung
caused by conditions such as asthma, chronic obstructive pulmonary disease (COPD), sleep apnea, or swelling of the
Diseases
airways.

Central
nervous
These diseases can interfere with normal breathing and not enough carbon dioxide is exhaled.
system
diseases

Drugs Certain drugs, such as narcotics and barbiturates, can slow the breathing rate and result in excess carbon dioxide.

Blocked
This can affect the amount of carbon dioxide that is expelled.
airways

Common causes of alkalosis

The table below provides examples of common causes of alkalosis:
COMMON CAUSES OF METABOLIC ALKALOSIS

Cause Examples of How Things Go Wrong

Kidney (renal)
Metabolic alkalosis may occur if the kidneys release too much acid into the urine.
problems

Excess loss of
This can be caused by severe dehydration or use of diuretics, which are medications that promote removal of fluid from
fluids and
the body.
minerals

Severe,
prolonged Prolonged vomiting may lead to the loss of too much stomach acid, causing alkalosis.
vomiting

Although it is rare, metabolic alkalosis may develop if someone swallows  too much base from an alkaline substance
Poisoning
like baking soda.

COMMON CAUSES OF RESPIRATORY ALKALOSIS

Hyperventilation
May lead to excessive loss of acid from the body through exhaling too much carbon dioxide. Hyperventilation can be
(Breathing
due to anxiety or pain or may be a physical response to lack of oxygen or shock, which occurs when tissues are not
abnormally fast
getting enough blood. Hyperventilation can also occur with medical problems such as fever, infection, or bleeding.
or deeply)

Shortness of May be caused by asthma, pneumonia, lung congestion due to heart failure, or a pulmonary embolism, which is a
 breath, difficulty blocked blood vessel in the lung
breathing

Mixed acid-base imbalances

More than one acid-base imbalance can occur at the same time. This is called a mixed acid-base disorder or a complex acid-base disturbance.
Mixed disorders happen when a patient has a condition that causes one type of imbalance then a second type of imbalance occurs.

For example, a patient with an alcohol abuse disorder may develop ketoacidosis due to alcohol misuse and metabolic alkalosis due to vomiting
with loss of stomach acid. The ketoacidosis increases the acidity of body fluids at the same time the loss of stomach acid decreases acidity.

Another example of a mixed acid-base disorder may occur due to aspirin poisoning. Aspirin triggers increased breathing, which can lead to
respiratory alkalosis due to hyperventilating. At the same time, aspirin is an acid, and large doses often cause metabolic acidosis.

Mixed acid-base disturbances may result in misleading test results that seem normal. Health care providers must carefully review laboratory test
results to determine whether a single or mixed acid-base imbalance is present.

Testing for Acidosis and Alkalosis

When an acid-base imbalance is suspected, your health care provider will evaluate your vital signs, including blood pressure, breath rate,
pulse, and temperature, and order tests to help diagnose or rule it out. If acidosis or alkalosis is detected, you may also have additional tests to
determine its cause. Some people may have testing for acidosis or alkalosis to follow up on abnormal results on a common screening test, such
as a complete metabolic panel (CMP).

Main tests
Diagnosis is typically based on the results of the following tests:
 Blood gases: Blood gases are a group of tests performed on a blood sample that is usually collected from an artery, instead of a vein.
Arteries are the blood vessels which carry blood from the heart to the rest of the body. Measurements of blood pH from an artery generally
better reflect what is going on in the body than blood from a vein. Blood gases provide measurements that are important for the diagnosis of
acidosis and alkalosis:
Blood pH
Carbon dioxide level, also called partial pressure of CO2, PaCO2 or PCO2
Oxygen level, also called partial pressure of O2, PaO2 or P02
Oxygen saturation, also called O2 Sat: determines oxygen levels based on measuring levels of hemoglobin. Hemoglobin is the protein
in red blood cells that is responsible for carrying oxygen throughout the body.
Bicarbonate
Electrolytes and anion gap: These tests measure minerals in the blood, including sodium, potassium, chloride, and bicarbonate.Your
health care team can use the results of this test to calculate your anion gap, which helps them narrow down the cause of acidosis and
distinguish between anion-gap and non-anion-gap metabolic acidosis. Electrolytes may be measured by themselves, or as part of a Basic
Metabolic Panel (BMP) or a Comprehensive Metabolic Panel (CMP).

Understanding acidosis and alkalosis test results

Blood gas results are interpreted in the context of your symptoms and history, as well as results from other tests performed at the same time.

Examples of test results associated with the four main acidosis and alkalosis conditions are provided in this table.

PH BICARBONATE CARBON DIOXIDE (PCO2) CONDITION

Low Low Low Metabolic acidosis

High High High Metabolic alkalosis

Low High High Respiratory acidosis

 High Low Low Respiratory alkalosis

Additional testing
Additional testing may be done to understand the cause of acidosis or alkalosis. This is important because treatment typically is directed at the
underlying cause. Testing may include one or more of the following, depending on the suspected cause:

SAMPLE
TEST WHY TEST IS PERFORMED 
TYPE

Blood or High blood sugar or sugar in urine may reveal undiagnosed or untreated diabetes as cause of
Glucose testing
urine acidosis

Urine or
Ketones Elevated level may help diagnose ketoacidosis
blood

Lactate Blood High levels of lactic acid (lactate) indicate lactic acidosis

Blood Urea Nitrogen

Blood This test helps evaluate how well the kidneys are working
(BUN)

Creatinine Blood Another test that indicates how well the kidneys are working

Can help detect alcohol poisoning; an expanded alcohol panel may also measure blood levels of
Alcohol Testing Blood
methanol and ethylene glycol
 Drug Testing Blood or May detect drugs that reduce breathing and can lead to respiratory acidosis
urine

Salicylate Acid
Blood High blood levels of salicylates (aspirin) may cause acidosis
(Aspirin) Testing

Osmolality and Blood or

May reveal imbalances due to poisoning from methanol or ethylene glycol
Osmolal Gap urine

Complete blood test

Blood Evaluates blood cells; may reveal, for example, a serious infection
(CBC)

Measures levels of protein, glucose (sugar), ketones, and urine pH; may provide diagnostic clues
Urinalysis Urine
about the cause of imbalance

Non-lab tests
Patients who are undergoing evaluation for acidosis and alkalosis may also have some of the following non-lab tests performed to determine
what might be the underlying cause:

Chest X-ray
CT scan of the chest
Pulmonary function tests
Electrocardiogram
Treatment of Acidosis and Alkalosis
Treatment of both acidosis and alkalosis is almost always directed at reversing the cause of the disorder. It is rare for alkaline or acid substances
to be given to restore balance.

Treatment of acidosis
How acidosis is treated will depend on what is causing it. For example, in metabolic acidosis caused by untreated diabetes, therapy may be
directed at controlling blood sugar with insulin. If acidosis is caused by breathing problems, treatment aims at improving lung function. If
breathing is severely impaired, mechanical ventilation may be needed.

Treatment of alkalosis
Metabolic alkalosis may be treated by giving fluids and electrolytes while treating the cause of fluid loss. Respiratory alkalosis is treated by
ensuring the patient has sufficient oxygen and treating the underlying cause of hyperventilating, such as an infection, pain, or anxiety.

Related Content

On This Site Elsewhere on the Web

Tests MedlinePlus Medical Encyclopedia: Acidosis
Electrolytes and Anion Gap MedlinePlus Medical Encyclopedia: Alkalosis

Sodium National Kidney Foundation: Metabolic Acidosis

Potassium MedlinePlus Medical Encyclopedia: Lactic acidosis 

Chloride American Diabetes Association: DKA (Ketoacidosis) & Ketones