Judgments based on history and clinical presentation of the patient play a critical role and many disorders associated with or manifested by acid-base imbalance require rapid diagnosis and intervention to avoid disastrous outcomes. Extreme degrees of imbalance are considered to be incompatible with life. Clinical signs of abnormal acidity may occasionally be prominent clues. Acidemia may present with hypotension, hypercapnia or obtundation. Alkalemia may present with paresthesias of the mouth and extremities, paralysis, muscular irritability, tetany or seizures.
Volume contraction is frequent in metabolic alkalosis.
Hyperventilation may be the initial clue to the presence of metabolic acidosis or respiratory alkalosis. Patients with respiratory acidosis may present with cyanosis. A detailed history and physical examination plays a major role in suspecting acid-base disorders and choosing further studies. Further analysis should be done to determine whether the disorder is simple or mixed. In most cases, treatment of the underlying cause is sufficient and often urgent.