Acidosis is a condition where the body’s fluids contain too much acid, leading to a drop in pH levels. It can result from either excessive acid production, reduced acid excretion, or a loss of bicarbonate, which acts as a base to neutralize acids. Acidosis can manifest in two primary forms: respiratory acidosis, which results from a buildup of carbon dioxide due to inadequate lung function, and metabolic acidosis, which occurs when there is an overproduction of acids or a reduction in the ability to remove them from the body.

Accurately diagnosing acidosis is crucial, as it can lead to serious health complications if left untreated. In this article, we’ll explore how acidosis is tested and diagnosed, the symptoms that prompt testing, and what specific tests healthcare professionals use to assess acid-base balance in the body.

1. Recognizing Symptoms of Acidosis

Before testing for acidosis, healthcare providers often look for common signs and symptoms that indicate the body may be in an acidic state. While these symptoms can vary depending on the severity and underlying cause of acidosis, they often include:

• Rapid or shallow breathing (especially in respiratory acidosis)

• Confusion or drowsiness

• Fatigue or general weakness

• Shortness of breath or difficulty breathing

• Nausea or vomiting

• Headaches

• Elevated heart rate

• Muscle cramps or twitching

• Chest pain

• A fruity breath odor (especially in diabetic ketoacidosis)

If these symptoms are present, further testing may be necessary to confirm whether acidosis is the cause.

2. Blood pH Testing (Arterial Blood Gas Test)

One of the primary ways to diagnose acidosis is through arterial blood gas (ABG) testing, which measures the pH level of the blood, as well as the levels of oxygen, carbon dioxide, and bicarbonate.

How the Test Works:

• A sample of arterial blood is drawn, typically from the wrist, and analyzed to measure its pH level and gas concentrations.

• Normal blood pH ranges from 7.35 to 7.45. A pH below 7.35 indicates acidosis.

In addition to pH, an ABG test will measure:

• PaCO₂ (partial pressure of carbon dioxide): Elevated PaCO₂ suggests respiratory acidosis, as it indicates the lungs are not removing enough carbon dioxide from the bloodstream.

• HCO₃⁻ (bicarbonate): Lower bicarbonate levels suggest metabolic acidosis, as the body is not neutralizing acids effectively.

Interpretation:

• If the blood pH is low and PaCO₂ is high, the diagnosis points toward respiratory acidosis.

• If the blood pH is low and HCO₃⁻ is low, it indicates metabolic acidosis.

ABG testing is considered the gold standard for diagnosing acidosis, as it directly measures blood pH and related gases.

3. Serum Electrolyte Testing

Electrolyte tests are often conducted alongside blood gas testing to help identify and diagnose acidosis, particularly metabolic acidosis. This test measures the levels of sodium, potassium, chloride, and bicarbonate in the blood, as these electrolytes are crucial for maintaining the body’s pH balance.

Key Measures in Serum Electrolyte Testing:

• Bicarbonate (HCO₃⁻): A low bicarbonate level in the blood is a key marker of metabolic acidosis. It shows the body’s ability to neutralize acid is reduced.

• Anion Gap: This calculation helps differentiate the causes of metabolic acidosis. The anion gap is the difference between positively charged and negatively charged electrolytes in the blood. A normal or elevated anion gap helps determine whether acidosis is caused by the accumulation of unmeasured acids (such as in diabetic ketoacidosis or lactic acidosis).

How the Anion Gap is Calculated:

The anion gap is calculated using the following formula:

A normal anion gap ranges between 8-12 mEq/L. An elevated anion gap (>12 mEq/L) suggests the presence of additional acids, such as in cases of:

• Diabetic ketoacidosis

• Lactic acidosis

• Renal failure

4. Urinalysis

Urinalysis is another important diagnostic tool for determining the underlying cause of acidosis. It assesses the pH of urine and detects the presence of abnormal substances, such as ketones or lactic acid, which can indicate metabolic acidosis.

What Urinalysis Measures:

• Urine pH: Normal urine pH ranges from 4.5 to 8.0. In metabolic acidosis, urine may become more acidic (lower pH) as the body tries to eliminate excess acid.

• Ketones: In conditions such as diabetic ketoacidosis (DKA), the presence of ketones in the urine indicates the body is producing large amounts of acidic ketone bodies due to a lack of insulin.

Urine pH testing can help distinguish between different types of metabolic acidosis and identify potential kidney-related issues that may be contributing to acid buildup.

5. Other Diagnostic Tests

Depending on the suspected cause of acidosis, additional tests may be performed to identify the underlying issue and confirm the diagnosis. Some of these tests include:

• Chest X-rays: In cases of respiratory acidosis, a chest X-ray may be used to identify lung-related causes of carbon dioxide buildup, such as pneumonia, chronic obstructive pulmonary disease (COPD), or pulmonary edema.

• Lactic Acid Blood Test: This test measures lactic acid levels in the blood. Elevated lactic acid indicates lactic acidosis, which can result from severe infections (sepsis), liver failure, or intense exercise.

• Kidney Function Tests: In metabolic acidosis, particularly if kidney disease is suspected, kidney function tests (such as blood urea nitrogen (BUN) and creatinine levels) help assess how well the kidneys are filtering acids and maintaining pH balance.

• Blood Sugar and Ketone Tests: In diabetic ketoacidosis (DKA), high blood sugar and elevated levels of ketones in the blood are the primary markers. Blood sugar tests and ketone tests can confirm the diagnosis of DKA.

6. Diagnosing Specific Types of Acidosis

Once the results of these tests are in, doctors will diagnose the specific type of acidosis and determine its cause. Here’s how the results guide diagnosis:

Respiratory Acidosis

• Cause: Occurs when the lungs are unable to remove enough carbon dioxide.

• Tests: ABG test showing low pH and high PaCO₂, along with potential findings on chest X-ray (lung disease).

Metabolic Acidosis

• Cause: Occurs when the body produces too much acid or the kidneys are unable to remove enough acid.

• Tests: ABG showing low pH and low bicarbonate, low serum bicarbonate in electrolyte testing, elevated anion gap (in cases of diabetic ketoacidosis, lactic acidosis), or normal anion gap (due to diarrhea or kidney tubular acidosis).

Conclusion: Timely Diagnosis is Crucial

Diagnosing acidosis involves a combination of blood and urine tests that measure pH, electrolyte levels, and gases such as carbon dioxide and bicarbonate. Early recognition of the symptoms, followed by appropriate testing, is essential to identifying the cause of acidosis and determining the right treatment plan.

Testing for acidosis can provide insight into underlying health conditions, such as respiratory disorders, kidney problems, diabetes, or severe infections. Prompt treatment can help restore the body’s pH balance and prevent complications associated with acidosis, such as organ damage, fatigue, and breathing difficulties. If you suspect symptoms of acidosis, seeking medical attention early is critical for effective diagnosis and care.