TY - CHAP
T1 - Acid-Base
AU - van Bochove, Victor A.
AU - Oudemans-van Straaten, Heleen M.
AU - Elbers, Paul W. G.
PY - 2015/1/1
Y1 - 2015/1/1
N2 - Stewart’s strong ion approach, Siggaard-Andersen’s standard base excess approach and the Henderson-Hasselbalch based bicarbonate centered approach are popular frameworks for understanding acid-base disorders in the critically ill. Basic concepts, views on renal acid-base handling and clinical application of these methods are discussed in this chapter. Provided that hypoalbuminemia is corrected for in the latter two, all methods are mathematically compatible and may perform equally well in clinical practice, especially in simple acid-base disorders. However, if acid-base disorders become increasingly complex, which is the case in many critically ill patients, Stewart’s approach may be superior. Although considered difficult, this method disentangles and quantifies the various factors responsible for complex mixed acid-base disorders, thus arguably providing the best overview. In addition, by explicitly clarifying the relationship between electrolyte disorders and acid-base physiology, the Stewart approach helps to demystify the effects of resuscitation fluids on acid-base balance. The kidney is pivotal in acid-base physiology, mostly by modifying the strong ion difference (SID). Our understanding of renal electrolyte handling may need to be revised as a result of the principles of the physiochemical approach. Both in acute and chronic kidney injury, accumulation of weak acids and impaired SID handling may give rise to complex acid-base disorders.
AB - Stewart’s strong ion approach, Siggaard-Andersen’s standard base excess approach and the Henderson-Hasselbalch based bicarbonate centered approach are popular frameworks for understanding acid-base disorders in the critically ill. Basic concepts, views on renal acid-base handling and clinical application of these methods are discussed in this chapter. Provided that hypoalbuminemia is corrected for in the latter two, all methods are mathematically compatible and may perform equally well in clinical practice, especially in simple acid-base disorders. However, if acid-base disorders become increasingly complex, which is the case in many critically ill patients, Stewart’s approach may be superior. Although considered difficult, this method disentangles and quantifies the various factors responsible for complex mixed acid-base disorders, thus arguably providing the best overview. In addition, by explicitly clarifying the relationship between electrolyte disorders and acid-base physiology, the Stewart approach helps to demystify the effects of resuscitation fluids on acid-base balance. The kidney is pivotal in acid-base physiology, mostly by modifying the strong ion difference (SID). Our understanding of renal electrolyte handling may need to be revised as a result of the principles of the physiochemical approach. Both in acute and chronic kidney injury, accumulation of weak acids and impaired SID handling may give rise to complex acid-base disorders.
UR - https://www.scopus.com/pages/publications/105012709322
U2 - 10.1007/978-3-319-17389-4_5
DO - 10.1007/978-3-319-17389-4_5
M3 - Chapter
SN - 9783319173887
T3 - Acute Nephrology for the Critical Care Physician
SP - 57
EP - 68
BT - Acute Nephrology for the Critical Care Physician
PB - Springer International Publishing
ER -