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Acidosi metabolica




 

L'acidosi metabolica è caratterizzata dall'aumento della concentrazione di idrogenioni nel sangue.L'acidosi metabolica può manifestarsi clinicamente con alterazioni talora caratteristiche.L'acidosi metabolica è un accumulo di acidi nell'organismo, non adeguatamente compensato da altrettante sostanze basiche.I soggetti con acidosi metabolica spesso presentano nausea, vomito e affaticamento e possono presentare una respirazione più veloce e più profonda del normale. Il trattamento per l'acidosi metabolica prevede la somministrazione di bicarbonato di sodio

Che cos’è l’acidosi metabolica?

L’acidosi metabolica è caratterizzata dall’aumento della concentrazione di idrogenioni nel sangue, con conseguente riduzione dei bicarbonati, del pH e della pCO2. 

Due sono i meccanismi fondamentali responsabili di acidosi metabolica:

  • Una riduzione della capacità di eliminare idrogeni da parte del rene.
  • Un aumento della concentrazione di idrogenioni per somministrazione esogena o per perdita di bicarbonato.

La genesi è spesso multifattoriale e l’acidosi metabolica che possono essere classificate sulla base del GA in:

  • Acidosi metaboliche ad elevato gap anionico
  • Acidosi metaboliche a gap anionico normale o ipercloremiche




Quali sono i sintomi?

L’acidosi metabolica può manifestarsi clinicamente con alterazioni talora caratteristiche, ma più frequentemente aspecifiche a carico del sistema nervoso, cardiovascolare, respiratorio, gastrointestinale, muscolo-scheletrico. Indipendentemente dall’ eziologia, l’acidosi può causare nausea e vomito, dolore addominale, alterazione del sensorio e tachipnea, talora con respiro di Kussmaul. Inoltre, l’acidosi può essere associata a ridotta forza muscolare, di contrazione cardiaca, di vasodilatazione arteriosa, vasocostrizione venosa e ipertensione polmonare.

Sistema cardiovascolare:

  • Palpitazioni, dolore toracico

Sistema nervoso:

  • Cefalea
  • Alterazioni del visus
  • Confusione mentale
  • Paralisi dei nervi cranici
  • Edema della retina

Sistema respiratorio:

  • Polipnea: la polipnea, in assenza di malattie polmonari note o manifeste manifeste, dovrebbe allertare il medico sulla possibilità di un’ acidosi metabolica sottostante.

Sistema gastrointestinale:

  • Nausea e vomito
  • Diarrea
  • Dolore addominale
  • Anoressia
  • Perdita di peso
  • Polifagia

Sistema muscolo scheletrico:

  • Astenia
  • Dolore osseo

Esami di laboratorio

  • Esami del sangue
  • Gap anionico. Questo test misura l’equilibrio chimico nel sangue.
  • Emogasanalisi arteriosa:permette di misurare i livelli di ossigeno e anidride carbonica presenti nel sangue arterioso e determinare l’acidità (pH) del sangue.
  • PH delle urine.

 




Come si cura l’acidosi metabolica?

Il trattamento dell’acidosi metabolica deve essere volto in primo luogo a correggere la causa. Il disturbo acido-basico non rappresenta, infatti, la patologia primitiva, ma il risultato clinico di un disordine patologico sottostante, che come tale,  va trattato e corretto. E’ importante anche tener presente che la rapidità della correzione deve essere proporzionale alla velocità con cui il disordine si è instaurato. Fondamentale nel trattamento dell’acidosi è correggere le alterazioni della ventilazione e della perfusione. La somministrazione di sali alcalini quali citrati e bicarbonati favorisce l’efflusso di acido lattico dai muscoli al torrente circolatorio e contrasta l’acidosi muscolare e metabolica.

 

 




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