Organic acidoses
A number of conditions are associated with the rapid build up of organic acids:
1. Diabetic ketoacidosis
The acid produced is β-hydroxybutyric acid. It is oxidised to acetoacetic acid. Because they are strong acids, they dissociate into H+ + A-, where A- is the associated anion which produces the increased anion gap.The presence of ketoacidosis can be detected my measuring serum ketones. Normal serum has no detectable ketones.
The anions produced in ketoacidosis are excreted rapidly following the administration of sodium chloride.
2. Other causes of ketoacidosis
Starvation may lead to accumulation of ketoacids, but at a much slower rate than in diabetic ketoacidosis.Heavy, chronic alcohol consumption can also cause ketoacidosis, due to excess production and decreased metabolism of ketoacids. Serum glucose levels will be normal or low and it is corrected by administration of glucose.
3. Lactic acidosis
Lactic acid accumulates as a result of anaerobic metabolism secondary to tissue hypoxia. It is identified by measuring serum lactate.