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Dialyse aktuell 2016; 20(04): 179-185
DOI: 10.1055/s-0042-106264
Nephrologie
© Georg Thieme Verlag Stuttgart · New York

Akute und chronische metabolische Azidose – Grundlagen und Relevanz für die Nephrologie

Acute and chronic metabolic acidodis – Baiscs and relevance in nephrology
Daniel Kitterer
1   Abteilung für Allgemeine Innere Medizin und Nephrologie, Robert-Bosch-Krankenhaus Stuttgart (Chefarzt: Prof. Dr. Mark Dominik Alscher)
,
Jörg Latus
1   Abteilung für Allgemeine Innere Medizin und Nephrologie, Robert-Bosch-Krankenhaus Stuttgart (Chefarzt: Prof. Dr. Mark Dominik Alscher)
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Publication Date:
01 June 2016 (online)

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Störungen des Säure-Basen-Haushaltes sind häufig und nicht immer leicht zu diagnostizieren. Zur Aufrechterhaltung der pH-Homöostase dienen das Bikarbonat-Puffer-System sowie das Nicht-Bikarbonat-Puffer-System. Beide Puffersysteme können Veränderungen des pH bei Zufuhr von Säuren oder Basen verhindern, allerdings können sie keine Säuren oder Basen aus dem Körper eliminieren. Zur Elimination von Säuren oder Basen werden die Lunge und die Nieren benötigt. Es lassen sich akute und chronische Störungen des Säure-Basen-Haushaltes unterscheiden. Prinzipiell gehen Veränderungen des pH-Wertes mit einem erhöhten Mortalitätsrisiko einher. Im Falle der akuten metabolischen Azidose scheint jedoch nicht die absolute Höhe des pH-Wertes die Prognose zu bestimmen, sondern vielmehr die zugrunde liegende Erkrankung. Dabei handelt es sich bei einer akuten metabolischen Azidose meist um eine metabolische Azidose mit erhöhter Anionenlücke (AL). Wird diese diagnostiziert, muss das Akronym „Kussmaul“ (Ketoazidose, Urämie, Salizylsäure, Methanol, (A)Ethylenglykol, Laktat) für exogen oder endogen zugeführte Säuren abgearbeitet werden. Die chronische metabolische Azidose präsentiert sich dagegen meist mit einer normalen AL. Hierbei ist die chronische Niereninsuffizienz (CNI) die wichtigste Differenzialdiagnose. Die chronische Azidose im Rahmen einer CNI ist ebenfalls mit einer erhöhten Mortalität assoziiert. Eine metabolische Azidose sollte immer standardisiert analysiert werden. Das wichtigste Hilfsmittel neben anamnestischen und klinischen Angaben v. a. zur Differenzierung ist die Berechnung der AL und der osmotischen Lücke (OL).

Acid-base disturbances are very common in everyday clinical practice and rapid recognition of the disturbances is mandatory. Metabolic acidosis can be divided into acute and chronic acidosis with and without elevated anion gap (AG). In patients with metabolic acidosis with elevated AG, the acronym “Kussmaul” (ketoacidosis, salicylates, methanol, (a)ethylene glycol, uremia, lactate) must be taken into account, whereas chronic metabolic acidosis often comes along with normal AG. Chronic kidney disease (CKD) is the most important reason for metabolic acidosis with normal AG that leads to an increased mortality. The work up of metabolic acidosis should always be done in a standardized manner. The most important tools are, besides medical history and clinical findings, the AG and the osmotic gap.

Key words

metabolic acidosis - chronic kidney disease - drug-induced acid-base disturbances - anion gap
 

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