In addition to the adaptive changes occurring in acidosis, a range of metabolic and pathophysiological changes occur; alkalosis tends to produce opposite but milder effects. The metabolism of carbohydrate is altered: both glycolysis and gluco-neogenesis are inhibited in the liver. Delivery of oxygen to the tissues is increased by the reduced ability of hemoglobin to retain oxygen in an acid environment (the Bohr effect). Consciousness is impaired, leading to coma in severe cases. However, the most important effects from a clinical perspective are cardiovascular: vasodilatation occurs in peripheral tissues, cardiac contractility is impaired resulting in reduced blood pressure, and, when severe, in reduced tissue perfusion. It is these effects that contribute to the adverse effects of acidosis in, for example, septic shock and contribute to the high mortality in these conditions.
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