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Published in: Critical Care 2/2005

01-04-2004 | Review

Bench-to-bedside review: Fundamental principles of acid-base physiology

Author: Howard E Corey

Published in: Critical Care | Issue 2/2005

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Abstract

Complex acid–base disorders arise frequently in critically ill patients, especially in those with multiorgan failure. In order to diagnose and treat these disorders better, some intensivists have abandoned traditional theories in favor of revisionist models of acid–base balance. With claimed superiority over the traditional approach, the new methods have rekindled debate over the fundmental principles of acid–base physiology. In order to shed light on this controversy, we review the derivation and application of new models of acid–base balance.
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Literature
1.
go back to reference Wooten EW: Analytic calculation of physiological acid–base parameters. J Appl Physiol 1999, 86: 326-334.PubMed Wooten EW: Analytic calculation of physiological acid–base parameters. J Appl Physiol 1999, 86: 326-334.PubMed
2.
go back to reference Stewart PA: How to understand acid base balance. In In A Quantitative Acid–Base Primer for Biology and Medicine. New York: Elsevier; 1981. Stewart PA: How to understand acid base balance. In In A Quantitative Acid–Base Primer for Biology and Medicine. New York: Elsevier; 1981.
3.
4.
go back to reference Constable PD: A simplified strong ion model for acid-base equilibria: application to horse plasma. J Appl Physiol 1997, 83: 297-311.PubMed Constable PD: A simplified strong ion model for acid-base equilibria: application to horse plasma. J Appl Physiol 1997, 83: 297-311.PubMed
5.
go back to reference Hasselbalch KA, Gammeltoft A: The neutral regulation of the gravid organism [in German]. Biochem Z 1915, 68: 206. Hasselbalch KA, Gammeltoft A: The neutral regulation of the gravid organism [in German]. Biochem Z 1915, 68: 206.
6.
go back to reference Hasselbalch KA: The 'reduced' and the 'regulated' hydrogen number of the blood [in German]. Biochem Z 1918, 174: 56. Hasselbalch KA: The 'reduced' and the 'regulated' hydrogen number of the blood [in German]. Biochem Z 1918, 174: 56.
7.
go back to reference Van Slyke DD: Studies of acidosis: XVII. The normal and abnormal variations in the acid base balance of the blood. J Biol Chem 1921, 48: 153. Van Slyke DD: Studies of acidosis: XVII. The normal and abnormal variations in the acid base balance of the blood. J Biol Chem 1921, 48: 153.
8.
go back to reference Siggaard-Andersen O: The pH-log PCO 2 blood acid–base nomogram revised. Scand J Clin Lab Invest 1962, 14: 598-604.CrossRef Siggaard-Andersen O: The pH-log PCO 2 blood acid–base nomogram revised. Scand J Clin Lab Invest 1962, 14: 598-604.CrossRef
9.
go back to reference Corey HE: Stewart and beyond: new models of acid-base balance. Kidney Int 2003, 64: 777-787. 10.1046/j.1523-1755.2003.00177.xCrossRefPubMed Corey HE: Stewart and beyond: new models of acid-base balance. Kidney Int 2003, 64: 777-787. 10.1046/j.1523-1755.2003.00177.xCrossRefPubMed
11.
go back to reference Constable PD: Clinical assessment of acid–base status. Strong ion difference theory. Vet Clin North Am Food Anim Pract 1999, 15: 447-472.PubMed Constable PD: Clinical assessment of acid–base status. Strong ion difference theory. Vet Clin North Am Food Anim Pract 1999, 15: 447-472.PubMed
12.
go back to reference Fencl V, Jabor A, Kazda A, Figge J: Diagnosis of metabolic acid-base disturbances in critically ill patients. Am J Respir Crit Care Med 2000, 162: 2246-2251.CrossRefPubMed Fencl V, Jabor A, Kazda A, Figge J: Diagnosis of metabolic acid-base disturbances in critically ill patients. Am J Respir Crit Care Med 2000, 162: 2246-2251.CrossRefPubMed
13.
go back to reference Jurado RL, Del Rio C, Nassar G, Navarette J, Pimentel JL Jr: Low anion gap. South Med J 1998, 91: 624-629.CrossRefPubMed Jurado RL, Del Rio C, Nassar G, Navarette J, Pimentel JL Jr: Low anion gap. South Med J 1998, 91: 624-629.CrossRefPubMed
14.
go back to reference McAuliffe JJ, Lind LJ, Leith DE, Fencl V: Hypoproteinemic alkalosis. Am J Med 1986, 81: 86-90. 10.1016/0002-9343(86)90187-7CrossRefPubMed McAuliffe JJ, Lind LJ, Leith DE, Fencl V: Hypoproteinemic alkalosis. Am J Med 1986, 81: 86-90. 10.1016/0002-9343(86)90187-7CrossRefPubMed
15.
go back to reference Rossing TH, Maffeo N, Fencl V: Acid–base effects of altering plasma protein concentration in human blood in vitro. J Appl Physiol 1986, 61: 2260-2265.PubMed Rossing TH, Maffeo N, Fencl V: Acid–base effects of altering plasma protein concentration in human blood in vitro. J Appl Physiol 1986, 61: 2260-2265.PubMed
16.
go back to reference Constable PD, Hinchcliff KW, Muir WW: Comparison of anion gap and strong ion gap as predictors of unmeasured strong ion concentration in plasma and serum from horses. Am J Vet Res 1998, 59: 881-887.PubMed Constable PD, Hinchcliff KW, Muir WW: Comparison of anion gap and strong ion gap as predictors of unmeasured strong ion concentration in plasma and serum from horses. Am J Vet Res 1998, 59: 881-887.PubMed
17.
go back to reference Kellum JA, Kramer DJ, Pinsky MR: Strong ion gap: a methodology for exploring unexplained anions. J Crit Care 1995, 10: 51-55. 10.1016/0883-9441(95)90016-0CrossRefPubMed Kellum JA, Kramer DJ, Pinsky MR: Strong ion gap: a methodology for exploring unexplained anions. J Crit Care 1995, 10: 51-55. 10.1016/0883-9441(95)90016-0CrossRefPubMed
18.
go back to reference Figge J, Jabor A, Kazda A, Fencl V: Anion gap and hypoalbuminemia. Crit Care Med 1998, 26: 1807-1810.CrossRefPubMed Figge J, Jabor A, Kazda A, Fencl V: Anion gap and hypoalbuminemia. Crit Care Med 1998, 26: 1807-1810.CrossRefPubMed
19.
go back to reference Constable PD: Total weak acid concentration and effective dissociation constant of nonvolatile buffers in human plasma. J Appl Physiol 2001, 91: 1364-1371.PubMed Constable PD: Total weak acid concentration and effective dissociation constant of nonvolatile buffers in human plasma. J Appl Physiol 2001, 91: 1364-1371.PubMed
20.
go back to reference Siggaard-Andersen O, Engel K: A new acid–base nomogram, an improved method for calculation of the relevant blood acid–base data. Scand J Clin Lab Invest 1960, 12: 177.CrossRef Siggaard-Andersen O, Engel K: A new acid–base nomogram, an improved method for calculation of the relevant blood acid–base data. Scand J Clin Lab Invest 1960, 12: 177.CrossRef
21.
go back to reference Siggaard-Andersen O: Blood acid–base alignment nomogram. Scales for pH, PCO 2 , base excess of whole blood of different hemoglobin concentrations, plasma bicarbonate and plasma total CO 2 . Scand J Clin Lab Invest 1963, 15: 211-217.CrossRef Siggaard-Andersen O: Blood acid–base alignment nomogram. Scales for pH, PCO 2 , base excess of whole blood of different hemoglobin concentrations, plasma bicarbonate and plasma total CO 2 . Scand J Clin Lab Invest 1963, 15: 211-217.CrossRef
22.
go back to reference Watson PD: Modeling the effects of proteins on pH in plasma. J Appl Physiol 1999, 86: 1421-1427.PubMed Watson PD: Modeling the effects of proteins on pH in plasma. J Appl Physiol 1999, 86: 1421-1427.PubMed
23.
go back to reference Figge J, Rossing TH, Fencl V: The role of serum proteins in acid–base equilibria. J Lab Clin Med 1991, 117: 453-467.PubMed Figge J, Rossing TH, Fencl V: The role of serum proteins in acid–base equilibria. J Lab Clin Med 1991, 117: 453-467.PubMed
24.
go back to reference Figge J, Mydosh T, Fencl V: Serum proteins and acid-base equilibria: a follow-up. J Lab Clin Med 1992, 120: 713-719.PubMed Figge J, Mydosh T, Fencl V: Serum proteins and acid-base equilibria: a follow-up. J Lab Clin Med 1992, 120: 713-719.PubMed
26.
go back to reference Davenport HW: The ABC of Acid–Base Chemistry. Chicago: University of Chicago Press; 1974. Davenport HW: The ABC of Acid–Base Chemistry. Chicago: University of Chicago Press; 1974.
27.
go back to reference Singer RB, Hastings AB: Improved clinical method for estimation of disturbances of acid-base balance of human blood. Medicine 1948, 27: 223-242.CrossRefPubMed Singer RB, Hastings AB: Improved clinical method for estimation of disturbances of acid-base balance of human blood. Medicine 1948, 27: 223-242.CrossRefPubMed
28.
go back to reference Wooten EW: Calculation of physiological acid–base parameters in multicompartment systems with application to human blood. J Appl Physiol 2003, 95: 2333-2344.CrossRefPubMed Wooten EW: Calculation of physiological acid–base parameters in multicompartment systems with application to human blood. J Appl Physiol 2003, 95: 2333-2344.CrossRefPubMed
Metadata
Title
Bench-to-bedside review: Fundamental principles of acid-base physiology
Author
Howard E Corey
Publication date
01-04-2004
Publisher
BioMed Central
Published in
Critical Care / Issue 2/2005
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc2985

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