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Intensive Care Medicine
Published in: Intensive Care Medicine 12/2009

01-12-2009 | Correspondence

Mixing bicarbonates: dilution acidosis from first principles

Author: Troels Ring

Published in: Intensive Care Medicine | Issue 12/2009

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Excerpt

Sir: In their recent paper, Doberer et al. [1] discuss the pathophysiology of dilution acidosis using a combination of simulations based on Stewart’s algorithm and simple experiments. Since acidosis is only found in open systems, they conclude that the classical model is confirmed, in which acidosis is thought to result from dilution of [HCO3 −] at unchanged pCO2. The notion of dilution must entail the direct predictability of the [HCO3 −] in a mixture from the respective volumes and [HCO3 −] in the constituent fluids. …
Footnotes
1
Take for instance the highest point in the curve for pCO2 = 100 mmHg. Assuming [H+] is additive (and hence for equal pCO2, [HCO3 −] is also additive), a [H+] of 6.070848e-07 would result instead of 1.517582e-07, and using this [H+] a new combined SID of 0.01193681 Eq/l would result, but we know it is 0.035 Eq/l, when mixing equal volumes of two fluids with SID 0.01 and 0.06 Eq/l.
 
Literature
1.
Doberer D, Funk G-C, Kirchner K, Schneeweiss B (2009) A critique of Stewart’s approach: the chemical mechanism of dilutional acidosis. Intensive Care Med. doi: 10.​1007/​s00134-009-1528-y, published online 17 June 2009
2.
Frassetto LA, Morris RC, Sebastian A (2007) Dietary sodium chloride intake independently predicts the degree of hyperchloremic metabolic acidosis in healthy humans consuming a net acid-producing diet. Am J Physiol 293:F521–F525CrossRef
3.
R Development Core Team (2008) R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. ISBN 3-900051-07-0. http://​www.​R-project.​org
Metadata
Title
Mixing bicarbonates: dilution acidosis from first principles
Author
Troels Ring
Publication date
01-12-2009
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 12/2009
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-009-1668-0

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