Acidosis and Alkalosis

Tests
The goals of testing are to identify whether an individual has an acid-base imbalance, to
determine how severe the imbalance is, and to help diagnose underlying diseases or conditions
(such as diabetic ketoacidosis or the ingestion of a toxin) that may have caused the acid-base
disturbance. Testing is also done to monitor critically ill people as well as those with conditions
known to affect acid-base balance, such as chronic lung disease and kidney disease.
The primary tests used to identify, evaluate, and monitor acid-base imbalances are:

Blood gases
Electrolytes

Blood gases are a group of tests performed together, usually on an arterial blood sample (blood
obtained from an artery instead of a vein). They are a snapshot of the blood's pH, pO2 (the
amount of oxygen in the blood), and pCO2 (the amount of carbon dioxide the blood). From these
results, bicarbonate (HCO3-) can be calculated.
In most acid-base disorders, both HCO3- and pCO2 are outside the reference range. That is
because the body tries to keep the pH close to normal. Therefore, if one of these substances is
abnormally high or low, the other one will change in order to bring the pH back toward its
healthy range. This process is called compensation. The table below shows the expected values
for each of the four main acid-base disorders.
Results seen in the four primary acid-base disorders:
Acid-Base
Disorder

pH

HCO3- PCO2

Body Compensation

Metabolic
acidosis

Less than
7.35

Low

Low

Increased breathing rate (hyperventilation) to

increase CO2 elimination

Metabolic
alkalosis

Greater than
High
7.45

High

Slowed breathing (hypoventilation) to decrease

CO2 elimination

Respiratory
acidosis

Less than
7.35

High

High

Kidney increases retention of HCO3- and excretion

of acid

Respiratory
alkalosis

Greater than
Low
7.45

Low

Kidney decreases retention of HCO3- and excretion

of acid

Electrolytes refers to a group of four tests: Na+ (sodium), K+ (potassium), Cl- (chloride), and
bicarbonate (usually measured as total CO2 content). Body fluid levels, electrolyte
concentrations, and acid-base balance are interconnected, and one or more of the electrolytes is
usually increased or decreased in metabolic acid-base disorders.
In a person with a metabolic acidosis, the anion gap is calculated using the results of an
electrolyte panel to help determine which disorders might be responsible for the acid-base
abnormality. For example, an increase in the anion gap can indicate diabetic ketoacidosis. (For
more on anion gap, see Common Questions #1 here.)
People with a metabolic alkalosis usually have low chloride (Cl-) and potassium (K+) values,
which again provides clues as to the cause of the acid-base disturbance.
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Based on these results, other tests may be ordered to diagnose the disease or condition that is
producing the acidosis or alkalosis. Some examples include:

Glucoseto detect and/or monitor diabetes

Lactatea high level indicates lactic acidosis

Ketonesa high level indicates ketoacidosis

Osmolalityevaluates water balance and may be used to detect a low sodium level or
toxins such as methanol and ethylene glycol

Emergency overdose and drug testing may detect one of several drugs or toxins

Complete blood count (CBC)this is a group of general tests, but a high white blood cell
(WBC) count may indicate sepsis

Urinalysisanother general test; a low or high urine pH may provide clues to the cause
of acidosis or alkalosis

It is possible for a person to have more than one acid-base disturbance at the same time.
Examples include ingestion of aspirin (which can produce both a respiratory alkalosis and
metabolic acidosis) and those with lung disease who are taking diuretics (respiratory acidosis
plus metabolic alkalosis). By using formulas to calculate the expected degree of compensation, it
is possible to determine if a mixed acid-base disorder is present.
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