Clinical review: Reunification of acid–base physiology

Recent advances in acid–base physiology and in the epidemiology of acid–base disorders have refined our understanding of the basic control mechanisms that determine blood pH in health and disease. These refinements have also brought parity between the newer, quantitative and older, descriptive approaches to acid–base physiology. This review explores how the new and older approaches to acid–base physiology can be reconciled and combined to result in a powerful bedside tool. A case based tutorial is also provided.

[1]  R. Bellomo,et al.  Acid–base status of critically ill patients with acute renal failure: analysis based on Stewart–Figge methodology , 2003, Critical care.

[2]  Severity of metabolic acidosis as a determinant of bicarbonate requirements. , 1973, The New England journal of medicine.

[3]  A. Grogono,et al.  ANIN-VIVO REPRESENTATION OF ACID-BASE BALANCE , 1976, The Lancet.

[4]  P. Gabow,et al.  The fall of the serum anion gap. , 1990, Archives of internal medicine.

[5]  A. Guz.  The Acid-Base Status of the Blood. 4th Edition , 1975 .

[6]  J. Vincent,et al.  Yearbook of Intensive Care and Emergency Medicine , 1995, Yearbook of Intensive Care and Emergency Medicine.

[7]  N. Madias,et al.  Influence of steady-state alterations in acid-base equilibrium on the fate of administered bicarbonate in the dog. , 1983, The Journal of clinical investigation.

[8]  J. G. van der Hoeven,et al.  Conventional or physicochemical approach in intensive care unit patients with metabolic acidosis , 2003, Critical care.

[9]  J. Kellum.  Closing the gap on unmeasured anions , 2003, Critical care.

[10]  J. Severinghaus.  Acid-base balance nomogram--a Boston-Copenhagen detente. , 1976, Anesthesiology.

[11]  O. Siggaard‐Andersen.  The acid-base status of the blood. , 1963, Scandinavian journal of clinical and laboratory investigation.

[12]  J. Kellum,et al.  Strong ion gap: a methodology for exploring unexplained anions. , 1995, Journal of critical care.

[13]  E. W. Wooten,et al.  Calculation of physiological acid-base parameters in multicompartment systems with application to human blood. , 2003, Journal of applied physiology.

[14]  E. W. Wooten.  Science review: Quantitative acid–base physiology using the Stewart model , 2004, Critical care.

[15]  P. Astrup,et al.  The acid-base metabolism. A new approach. , 1960, Lancet.

[16]  Andersen Os.  The pH-log pCO2 blood acid-base nomogram revised. , 1962 .

[17]  H. Corey.  Bench-to-bedside review: Fundamental principles of acid-base physiology , 2004, Critical care.

[18]  J. Kellum.  Determinants of plasma acid-base balance. , 2005, Critical care clinics.

[19]  H. Corey.  Stewart and beyond: new models of acid-base balance. , 2003, Kidney international.

[20]  Rinaldo Bellomo,et al.  Critical Care Nephrology , 1998, Springer Netherlands.

[21]  P. Havens,et al.  Unmeasured anions identified by the Fencl-Stewart method predict mortality better than base excess, anion gap, and lactate in patients in the pediatric intensive care unit. , 1999, Critical care medicine.

[22]  O S ANDERSEN,et al.  The pH-log pCO2 blood acid-base nomogram revised. , 1962, Scandinavian journal of clinical and laboratory investigation.

[23]  P. Lochhead,et al.  The strong ion gap does not have prognostic value in critically ill patients in a mixed medical/surgical adult ICU , 2002, Intensive Care Medicine.

[24]  J. Kellum.  Acid-base physiology in the post-Copernican era , 1999 .

[25]  S. Magder.  Pathophysiology of metabolic acid-base disturbances in patients with critical illness , 1998 .

[26]  S. Tibby,et al.  The strong ion gap predicts mortality in children following cardiopulmonary bypass surgery* , 2005, Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

[27]  N. Day,et al.  Unidentified acids of strong prognostic significance in severe malaria* , 2004, Critical care medicine.

[28]  P A Stewart,et al.  Modern quantitative acid-base chemistry. , 1983, Canadian journal of physiology and pharmacology.

[29]  W. Schwartz,et al.  CARBON DIOXIDE TITRATION CURVE OF NORMAL MAN. EFFECT OF INCREASING DEGREES OF ACUTE HYPERCAPNIA ON ACID-BASE EQUILIBRIUM. , 1965, The New England journal of medicine.

[30]  S. Alper,et al.  Defects in processing and trafficking of the AE1 Cl−/HCO3− exchanger associated with inherited distal renal tubular acidosis , 2004, Journal of Clinical and Experimental Nephrology.

[31]  V. Fencl,et al.  Serum proteins and acid-base equilibria: a follow-up. , 1992, The Journal of laboratory and clinical medicine.

[32]  R. M. Cohen,et al.  The concept of bicarbonate distribution space: the crucial role of body buffers. , 1989, Kidney international.

[33]  B. Gilfix,et al.  A physical chemical approach to the analysis of acid-base balance in the clinical setting. , 1993, Journal of critical care.

[34]  R. Bellomo,et al.  Splanchnic buffering of metabolic acid during early endotoxemia. , 1997, Journal of critical care.

[35]  R. Bellomo,et al.  Hepatic anion flux during acute endotoxemia. , 1995, Journal of applied physiology.

[36]  R. Bellomo,et al.  The aetiology and pathogenesis of cardiopulmonary bypass-associated metabolic acidosis using polygeline pump prime , 1999, Intensive Care Medicine.

[37]  Rinaldo Bellomo,et al.  Unmeasured anions in critically ill patients: Can they predict mortality?* , 2003, Critical care medicine.

[38]  J. Kellum,et al.  Initial pH, base deficit, lactate, anion gap, strong ion difference, and strong ion gap predict outcome from major vascular injury* , 2004, Critical care medicine.

[39]  Peter Stewart,et al.  How to understand acid-base : a quantitative acid-base primer for biology and medicine , 1981 .

[40]  S. Mujais,et al.  Gaps in the anion gap. , 1992, Archives of internal medicine.

[41]  R. Bellomo,et al.  ETIOLOGY OF METABOLIC ACIDOSIS DURING SALINE RESUSCITATION IN ENDOTOXEMIA , 1998, Shock.

[42]  R. B. Singer,et al.  AN IMPROVED CLINICAL METHOD FOR THE ESTIMATION OF DISTURBANCES OF THE ACID‐BASE BALANCE OF HUMAN BLOOD , 1948, Medicine.

[43]  J. Kellum.  Determinants of blood pH in health and disease , 2000, Critical care.

[44]  A. Grogono,et al.  An in-vivo representation of acid-base balance. , 1976, Lancet.

[45]  J. Kellum.  Making Strong Ion Difference the "Euro" for Bedside Acid-Base Analysis , 2005 .

[46]  G. R. Kelman,et al.  Determination of the in vivo carbon dioxide titration curve of anaesthetized man. , 1966, British journal of anaesthesia.

[47]  M. Emmett.  Simple and Mixed Acid‐Base Disorders: A Practical Approach , 1980, Medicine.

[48]  P. Constable,et al.  A simplified strong ion model for acid-base equilibria: application to horse plasma. , 1997, Journal of applied physiology.

[49]  J. Severinghaus,et al.  Human PaCO2 and standard base excess compensation for acid-base imbalance. , 1998, Critical care medicine.

[50]  R Bellomo,et al.  Release of lactate by the lung in acute lung injury. , 1997, Advances in experimental medicine and biology.

[51]  E. W. Wooten.  Analytic calculation of physiological acid-base parameters in plasma. , 1999, Journal of applied physiology.

[52]  T. J. Morgan,et al.  Crystalloid strong ion difference determines metabolic acid-base change during in vitro hemodilution , 2002, Critical care medicine.

[53]  O. Siggaard‐Andersen,et al.  The van Slyke equation. , 1977, Scandinavian journal of clinical and laboratory investigation. Supplementum.