Diagnosis of Acidosis

Acidosis Diagnosis: Book Excerpts

• Ask the following questions - ACIDOSIS (DECREASED PH)
• Differential Diagnosis - Metabolic Acidosis
• Approach to the Diagnosis - ACIDOSIS (DECREASED PH)
• History and physical examination - Breath with fruity odor
• Diagnosis - Metabolic acidosis
• Diagnosis - Renal tubular acidosis
• History and physical examination - Breath with fruity odor
• Diagnosis - Renal tubular acidosis
• Diagnosis - Respiratory acidosis
• History - Breath odor, fruity
• History - Breath with fruity odor
• History and physical examination - Breath with fruity odor
• Approach to the Diagnosis - ACIDOSIS (DECREASED pH)

Diagnostic Tests for Acidosis: Online Medical Books

16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about diagnostis of Acidosis.

ACIDOSIS (DECREASED PH): Ask the following questions:
(Algorithmic Diagnosis of Symptoms and Signs)

1. What is the blood glucose and serum acetone level? If these are increased, consider diabetic acidosis. If these are normal, consider other causes of acidosis.
2. What is the bicarbonate level? An increased bicarbonate level points to respiratory acidosis, whereas a decreased bicarbonate level points to renal disease, diarrhea, and the use of certain diuretics.

DIAGNOSTIC WORKUP

This should include a CBC, chemistry panel, electrolytes, arterial blood gas analysis, serum and urine ketones, lactic acid, pulmonary function tests, EKG, and consultation with a pulmonologist or nephrologist.

» READ BOOK EXCERPT ONLINE »

Source: Algorithmic Diagnosis of Symptoms and Signs, 2003

Metabolic Acidosis: Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)

• Increased anion gap (AG) metabolic acidosis, due to production of exogenous acid “MUDPILES”

• Methanol
• Uremia
• DKA
• Paraldehyde
• Ingestions/inborn errors of metabolism
• Lactic acidosis
• Ethylene glycol
• Salicylates

• Normal anion gap metabolic acidosis, due to bicarbonate loss in the GI tract or kidneys or impaired acid secretion by the kidney
  –Diarrhea, other GI losses (very common)
  –Type I (distal) renal tubular acidosis (RTA): Inability to excrete hydrogen ion, urine pH always high (>6.5), caused by a variety of medications, inherited forms, or renal insufficiency; often associated with low potassium and hypercalciuria
  –Type II (proximal) RTA: Impaired reabsorption of bicarbonate from the proximal tubule, usually associated with other evidence of proximal tubule dysfunction (Fanconi syndrome), such as phosphaturia or glycosuria
  –Type IV (hyperkalemic) RTA: Inadequate aldosterone production or inability to respond appropriately to aldosterone; commonly seen in patients with a history of obstructive uropathy or as a transient occurrence in patients with acute pyelonephritis

Workup and Diagnosis

• History
  –Symptoms of fever, flank pain and vomiting (pyelonephritis), lethargy/altered mental status (intoxication or metabolic disease)
  – GI losses (diarrhea), ingestions, poor growth, increased or decreased urine output, history of urinary tract abnormalities (e.g., congenital obstructive uropathy)
  –Family history of kidney disease, kidney stones, metabolic disease, early infant deaths

• Physical exam: Assessment of hydration status (heart rate, blood pressure, mucous membranes, skin perfusion), growth parameters, respiratory status (tachypnea suggests either primary respiratory process or respiratory compensation for severe metabolic acidosis) abdominal exam, complete neurologic exam
• Labs
  –Chemistry panel
  –Calculation of AG =[Na⁺] – [HCO_3- +Cl^–]; normal =10–12; when increased anion gap is due to exogenous acid, AG is often ≥20
  –Venous blood gas, if the etiology of the acidosis is unclear (i.e., primary vs secondary); urinalysis (to help distinguish proximal vs distal RTA)
  • Additional evaluation based on the clinical situation, e.g., toxicology, metabolic screens (increased AG acidosis), renal ultrasound (nephrocalcinosis with type I RTA)

» READ BOOK EXCERPT ONLINE »

Source: In A Page: Pediatric Signs and Symptoms, 2007

ACIDOSIS (DECREASED PH): Approach to the Diagnosis
(Differential Diagnosis in Primary Care)

The laboratory will be of greatest assistance in determining the cause of acidosis. An elevated blood sugar and serum acetone level will help diagnose diabetic acidosis. An elevated blood urea nitrogen (BUN) would point to uremia acidosis. Arterial blood gases may show an increased CO2, isolating pulmonary emphysema as the cause.

» READ BOOK EXCERPT ONLINE »

Source: Differential Diagnosis in Primary Care, 2007

Breath with fruity odor: History and physical examination
(Handbook of Signs & Symptoms (Third Edition))

If the patient isn't in severe distress, obtain a thorough history. Ask about the onset and duration of fruity breath odor. Find out about changes in breathing pattern. Ask about increased thirst, frequent urination, weight loss, fatigue, and abdominal pain. Ask the female patient if she has had candidal vaginitis or vaginal secretions with itching. If the patient has a history of diabetes mellitus, ask about stress, infections, and noncompliance with therapy — the most common causes of ketoacidosis in known diabetics. If the patient is suspected of having anorexia nervosa, obtain a dietary and weight history.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Signs & Symptoms (Third Edition), 2006

Metabolic acidosis: Diagnosis
(Professional Guide to Diseases (Eighth Edition))

Confirming diagnosis  Arterial pH below 7.35 confirms metabolic acidosis. In severe acidotic states, pH may fall to 7.10, and the partial pressure of arterial carbon dioxide may be normal or below 34 mm Hg as compensatory mechanisms take hold. Bicarbonate may be below 22 mEq/L.

A metabolic panel can help reveal the cause and severity of metabolic acidosis. A complete blood count can be done to help assess possible causes as well. Supportive findings include:

❑ urine pH: below 4.5 in the absence of renal disease

❑ serum potassium levels: above 5.5 mEq/L from chemical buffering

❑ glucose levels: above 150 mg/dl in diabetes

❑ serum ketone bodies: elevated levels in diabetes mellitus

❑ serum osmolarity: increased levels, as in hyperosmolar hyperglycemic nonketotic acidosis or dehydration

❑ plasma lactic acid: elevated levels in lactic acidosis

❑ anion gap: greater than 14 mEq/L indicating metabolic acidosis (diabetic ketoacidosis, aspirin overdose, alcohol poisoning). (See Anion gap.)

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Renal tubular acidosis: Diagnosis
(Professional Guide to Diseases (Eighth Edition))

CONFIRMING DIAGNOSIS Demonstration of impaired acidification of urine with systemic metabolic acidosis confirms distal RTA. Demonstration of bicarbonate wasting due to impaired reabsorption confirms proximal RTA.

Other relevant laboratory results show:

❑ decreased serum bicarbonate, pH, potassium, and phosphorus

❑ increased serum chloride and alkaline phosphatase

❑ alkaline pH, with low titratable acids and ammonium content in urine; increased urinary bicarbonate and potassium; low specific gravity.

In later stages, X-rays may show nephrocalcinosis.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Breath with fruity odor: History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))

If the patient isn’t in severe distress, obtain a thorough history. Ask about the onset and duration of fruity breath odor. Also ask about any changes in breathing pattern, increased thirst, frequent urination, weight loss, fatigue, and abdominal pain. Ask the female patient if she has had candidal vaginitis or vaginal secretions with itching. If the patient has a history of diabetes mellitus, ask about stress, infections, and noncompliance with therapy—the most common causes of ketoacidosis in known diabetics. If the patient is suspected of having anorexia nervosa, obtain a dietary and weight history.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Renal tubular acidosis: Diagnosis
(Handbook of Diseases)

Demonstration of impaired urine acidification with systemic metabolic acidosis confirms distal RTA. Demonstration of bicarbonate wasting from impaired reabsorption confirms proximal RTA.

Other relevant laboratory results show the following:

❑ decreased serum bicarbonate, pH, potassium, and phosphorus levels

❑ increased serum chloride and alkaline phosphatase levels

❑ alkaline pH, with low titratable acids and ammonium content in urine; and increased urinary bicarbonate and potassium levels, with low specific gravity.

In later stages, X-rays may show nephrocalcinosis.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Diseases, 2003

Respiratory acidosis: Diagnosis
(Handbook of Diseases)

❑ The following arterial blood gas (ABG) levels confirm respiratory acidosis: a Paco₂ exceeding the normal level of 45 mm Hg, pH usually below the normal range of 7.35 to 7.45, and a bicarbonate level that’s normal in the acute stage but elevated in the chronic stage.

❑ Chest X-ray, computed tomography scan, or pulmonary function test may help diagnose lung disease.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Diseases, 2003

Breath odor, fruity: History
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)

If the patient isn’t in severe distress, obtain a thorough history. Ask about the onset and duration of fruity breath odor. Find out about changes in breathing pattern. Ask about increased thirst, frequent urination, weight loss, fatigue, and abdominal pain. Ask the female patient if she has had candidal vaginitis or vaginal secretions with itching. If the patient has a history of diabetes mellitus, ask about stress, infections, and adherence to the treatment regimen. If you suspect that the patient has anorexia nervosa, obtain a dietary and weight history.

Physical examination

Perform a full neurologic examination, noting the patient’s LOC. Assess him for signs of dehydration and shock. Assess the patient’s GI system.

» READ BOOK EXCERPT ONLINE »

Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007

Breath with fruity odor: History
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

If the patient isn’t in severe distress, obtain a thorough history. Ask about the onset and duration of fruity breath odor. Find out about any changes in breathing pattern. Ask about increased thirst, frequent urination, weight loss, fatigue, and abdominal pain. Ask the female patient if she has had candidal vaginitis or vaginal secretions with itching. If the patient has a history of diabetes mellitus, ask about stress, infections, and noncompliance with therapy — the most common causes of ketoacidosis in a patient with diabetes. If the patient is suspected of having anorexia nervosa, obtain a dietary and weight history.

» READ BOOK EXCERPT ONLINE »

Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

Breath with fruity odor: History and physical examination
(Nursing: Interpreting Signs and Symptoms)

If the patient isn't in severe distress, obtain a thorough history. Ask about the onset and duration of fruity breath odor. Find out about changes in breathing pattern. Ask about increased thirst, frequent urination, weight loss, fatigue, and abdominal pain. Ask the female patient if she has had candidal vaginitis or vaginal secretions with itching. If the patient has a history of diabetes mellitus, ask about stress, infections, and noncompliance with therapy—the most common causes of ketoacidosis in known diabetics. If the patient is suspected of having anorexia nervosa, obtain a dietary and weight history.

» READ BOOK EXCERPT ONLINE »

Source: Nursing: Interpreting Signs and Symptoms, 2007

ACIDOSIS (DECREASED pH): Approach to the Diagnosis
(Differential Diagnosis in Primary Care)

The laboratory will be of greatest assistance in determining the cause of acidosis. An elevated blood sugar and serum acetone level will help diagnose diabetic acidosis. An elevated blood urea nitrogen (BUN) level would point to uremia acidosis. Arterial blood gases may show an increased CO₂, isolating pulmonary emphysema as the cause.

» READ BOOK EXCERPT ONLINE »

Source: Differential Diagnosis in Primary Care, 2007

 » Next page: Signs of Acidosis

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