Skip to main content
Erschienen in: Critical Care 5/2005

01.10.2005 | Review

Clinical review: Reunification of acid–base physiology

verfasst von: John A Kellum

Erschienen in: Critical Care | Ausgabe 5/2005

Einloggen, um Zugang zu erhalten

Abstract

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.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
1.
Zurück zum Zitat 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
3.
Zurück zum Zitat Wooten EW: Analytic claculation of physiological acid-base parameters in plasma. J Appl Physiol 1999, 86: 326-334.PubMed Wooten EW: Analytic claculation of physiological acid-base parameters in plasma. J Appl Physiol 1999, 86: 326-334.PubMed
4.
Zurück zum Zitat 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
6.
Zurück zum Zitat Shayakul C, Alper SL: Defects in processing and trafficking of the AE1 Cl-/HCO3- exchanger associated with inherited distal renal tubular acidosis. Clin Exp Nephrol 2004, 8: 1-11. 10.1007/s10157-003-0271-xCrossRefPubMed Shayakul C, Alper SL: Defects in processing and trafficking of the AE1 Cl-/HCO3- exchanger associated with inherited distal renal tubular acidosis. Clin Exp Nephrol 2004, 8: 1-11. 10.1007/s10157-003-0271-xCrossRefPubMed
8.
Zurück zum Zitat Kellum JA, Bellomo R, Kramer DJ, Pinsky MR: Splanchnic buffering of metabolic acid during early endotoxemia. J Crit Care 1997, 12: 7-12. 10.1016/S0883-9441(97)90020-4CrossRefPubMed Kellum JA, Bellomo R, Kramer DJ, Pinsky MR: Splanchnic buffering of metabolic acid during early endotoxemia. J Crit Care 1997, 12: 7-12. 10.1016/S0883-9441(97)90020-4CrossRefPubMed
9.
Zurück zum Zitat Schlichtig R, Grogono AW, Severinghaus JW: Human PaCO 2 and standard base excess compensation for acid-base imbalance. Crit Care Med 1998, 26: 1173-1179. 10.1097/00003246-199807000-00015CrossRefPubMed Schlichtig R, Grogono AW, Severinghaus JW: Human PaCO 2 and standard base excess compensation for acid-base imbalance. Crit Care Med 1998, 26: 1173-1179. 10.1097/00003246-199807000-00015CrossRefPubMed
10.
Zurück zum Zitat Kellum JA: Making strong ion difference the "Euro" for bedside acid-base analysis. In Yearbook of Intensive Care and Emergency Medicine. Edited by: Vincent JL. Berlin: Springer-Verlag; 2005:675-685. Kellum JA: Making strong ion difference the "Euro" for bedside acid-base analysis. In Yearbook of Intensive Care and Emergency Medicine. Edited by: Vincent JL. Berlin: Springer-Verlag; 2005:675-685.
11.
Zurück zum Zitat Kellum JA: Determinants of plasma acid-base balance. Crit Care Clin 2005, 21: 329-346. 10.1016/j.ccc.2005.01.010CrossRefPubMed Kellum JA: Determinants of plasma acid-base balance. Crit Care Clin 2005, 21: 329-346. 10.1016/j.ccc.2005.01.010CrossRefPubMed
12.
Zurück zum Zitat Stewart P: Modern quantitative acid-base chemistry. Can J Physiol Pharmacol 1983, 61: 1444-1461.CrossRefPubMed Stewart P: Modern quantitative acid-base chemistry. Can J Physiol Pharmacol 1983, 61: 1444-1461.CrossRefPubMed
13.
Zurück zum Zitat Stewart PA: How to Understand Acid-base: A Quantitative Acid-base Primer for Biology and Medicine. 1st edition. New York: Elsevier; 1981. Stewart PA: How to Understand Acid-base: A Quantitative Acid-base Primer for Biology and Medicine. 1st edition. New York: Elsevier; 1981.
16.
Zurück zum Zitat Kellum JA: Acid-base physiology in the post-Copernican era. Curr Opin Crit Care 1999, 5: 429-435. 10.1097/00075198-199912000-00003CrossRef Kellum JA: Acid-base physiology in the post-Copernican era. Curr Opin Crit Care 1999, 5: 429-435. 10.1097/00075198-199912000-00003CrossRef
17.
Zurück zum Zitat Magder S: Pathophysiology of metabolic acid-base disturbances in patients with critical illness. In Critical Care Nephrology. Edited by: Ronco C, Bellomo R. Dordrecht, The Netherlands: Kluwer Academic Publishers; 1997:279-296. Magder S: Pathophysiology of metabolic acid-base disturbances in patients with critical illness. In Critical Care Nephrology. Edited by: Ronco C, Bellomo R. Dordrecht, The Netherlands: Kluwer Academic Publishers; 1997:279-296.
18.
Zurück zum Zitat 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
19.
Zurück zum Zitat Fernandez PC, Cohen RM, Feldman GM: The concept of bicarbonate distribution space: the crucial role of body buffers. Kidney Int 1989, 36: 747-752.CrossRefPubMed Fernandez PC, Cohen RM, Feldman GM: The concept of bicarbonate distribution space: the crucial role of body buffers. Kidney Int 1989, 36: 747-752.CrossRefPubMed
20.
Zurück zum Zitat Garella S, Dana CL, Chazan JA: Severity of metabolic acidosis as a determinant of bicarbonate requirements. N Engl J Med 1973, 289: 121-126.CrossRefPubMed Garella S, Dana CL, Chazan JA: Severity of metabolic acidosis as a determinant of bicarbonate requirements. N Engl J Med 1973, 289: 121-126.CrossRefPubMed
21.
Zurück zum Zitat Androgue HJ, Brensilver J, Cohen JJ, Madias NE: Influence of steady-state alterations in acid-base equilibrium on the fate of administered bicarbonate in the dog. J Clin Invest 1983, 71: 867-883.CrossRef Androgue HJ, Brensilver J, Cohen JJ, Madias NE: Influence of steady-state alterations in acid-base equilibrium on the fate of administered bicarbonate in the dog. J Clin Invest 1983, 71: 867-883.CrossRef
22.
Zurück zum Zitat Singer RB, Hastings AB: An improved clinical method for the estimation of disturbances of the acid-base balance of human blood. Medicine (Baltimore) 1948, 27: 223-242.CrossRef Singer RB, Hastings AB: An improved clinical method for the estimation of disturbances of the acid-base balance of human blood. Medicine (Baltimore) 1948, 27: 223-242.CrossRef
23.
Zurück zum Zitat Astrup P, Jorgensen K, Siggaard-Andersen O: Acid-base metabolism: New approach. Lancet 1960, 1: 1035-1039. 10.1016/S0140-6736(60)90930-2CrossRefPubMed Astrup P, Jorgensen K, Siggaard-Andersen O: Acid-base metabolism: New approach. Lancet 1960, 1: 1035-1039. 10.1016/S0140-6736(60)90930-2CrossRefPubMed
24.
Zurück zum Zitat Siggaard-Andersen O: The pH-log PCO2 blood acid-base nomogram revised. Scand J Clin Lab Invest 1962, 14: 598-604.CrossRef Siggaard-Andersen O: The pH-log PCO2 blood acid-base nomogram revised. Scand J Clin Lab Invest 1962, 14: 598-604.CrossRef
25.
Zurück zum Zitat Grogono AW, Byles PH, Hawke W: An in vivo representation of acid-base balance. Lancet 1976, 1: 499-500. 10.1016/S0140-6736(76)90792-3CrossRefPubMed Grogono AW, Byles PH, Hawke W: An in vivo representation of acid-base balance. Lancet 1976, 1: 499-500. 10.1016/S0140-6736(76)90792-3CrossRefPubMed
26.
Zurück zum Zitat Severinghaus JW: Acid-base balance nomogram – a Boston-Copenhagen détente. Anesthesiology 1976, 45: 539-541.CrossRefPubMed Severinghaus JW: Acid-base balance nomogram – a Boston-Copenhagen détente. Anesthesiology 1976, 45: 539-541.CrossRefPubMed
27.
Zurück zum Zitat Siggaard-Andersen O: The Acid-base Status of the Blood. 4th edition. Baltimore, MD: William and Wilkins; 1974. Siggaard-Andersen O: The Acid-base Status of the Blood. 4th edition. Baltimore, MD: William and Wilkins; 1974.
28.
Zurück zum Zitat Siggaard-Andersen O: The Van Slyke equation. Scand J Clin Lab Invest 1977, 146: 15-20.CrossRef Siggaard-Andersen O: The Van Slyke equation. Scand J Clin Lab Invest 1977, 146: 15-20.CrossRef
29.
Zurück zum Zitat Brackett NC, Cohen JJ, Schwartz WB: Carbon dioxide titration curve of normal man. N Engl J Med 1965, 272: 6-12.CrossRefPubMed Brackett NC, Cohen JJ, Schwartz WB: Carbon dioxide titration curve of normal man. N Engl J Med 1965, 272: 6-12.CrossRefPubMed
30.
Zurück zum Zitat Prys-Roberts C, Kelman GR, Nunn JF: Determinants of the in vivo carbon dioxide titration curve in anesthetized man. Br J Anesth 1966, 38: 500-550.CrossRef Prys-Roberts C, Kelman GR, Nunn JF: Determinants of the in vivo carbon dioxide titration curve in anesthetized man. Br J Anesth 1966, 38: 500-550.CrossRef
31.
Zurück zum Zitat 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
32.
Zurück zum Zitat Narins RG, Emmett M: Simple and mixed acid-base disorders: A practical approach. Medicine (Baltimore) 1980, 59: 161-187.CrossRef Narins RG, Emmett M: Simple and mixed acid-base disorders: A practical approach. Medicine (Baltimore) 1980, 59: 161-187.CrossRef
34.
Zurück zum Zitat Winter SD, Pearson R, Gabow PG, Schultz A, Lepoff RB: The fall of the serum anion gap. Arch Intern Med 1990, 150: 3113-3115. 10.1001/archinte.150.2.311CrossRef Winter SD, Pearson R, Gabow PG, Schultz A, Lepoff RB: The fall of the serum anion gap. Arch Intern Med 1990, 150: 3113-3115. 10.1001/archinte.150.2.311CrossRef
35.
Zurück zum Zitat Salem MM, Mujais SK: Gaps in the anion gap. Arch Intern Med 1992, 152: 1625-1629. 10.1001/archinte.152.8.1625CrossRefPubMed Salem MM, Mujais SK: Gaps in the anion gap. Arch Intern Med 1992, 152: 1625-1629. 10.1001/archinte.152.8.1625CrossRefPubMed
36.
Zurück zum Zitat Gilfix BM, Bique M, Magder S: A physical chemical approach to the analysis of acid-base balance in the clinical setting. J Crit Care 1993, 8: 187-197. 10.1016/0883-9441(93)90001-2CrossRefPubMed Gilfix BM, Bique M, Magder S: A physical chemical approach to the analysis of acid-base balance in the clinical setting. J Crit Care 1993, 8: 187-197. 10.1016/0883-9441(93)90001-2CrossRefPubMed
37.
Zurück zum Zitat 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
38.
Zurück zum Zitat Kellum JA, Bellomo R, Kramer DJ, Pinsky MR: Hepatic anion flux during acute endotoxemia. J Appl Physiol 1995, 78: 2212-2217.PubMed Kellum JA, Bellomo R, Kramer DJ, Pinsky MR: Hepatic anion flux during acute endotoxemia. J Appl Physiol 1995, 78: 2212-2217.PubMed
39.
Zurück zum Zitat Moviat M, van Haren F, van der Hoeven H: Conventional or physicochemical approach in intensive care unit patients with metabolic acidosis. Crit Care 2003, 7: R41-R45. 10.1186/cc2184PubMedCentralCrossRefPubMed Moviat M, van Haren F, van der Hoeven H: Conventional or physicochemical approach in intensive care unit patients with metabolic acidosis. Crit Care 2003, 7: R41-R45. 10.1186/cc2184PubMedCentralCrossRefPubMed
40.
Zurück zum Zitat Balasubramanyan N, Havens PL, Hoffman GM: 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. Crit Care Med 1999, 27: 1577-1581. 10.1097/00003246-199908000-00030CrossRefPubMed Balasubramanyan N, Havens PL, Hoffman GM: 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. Crit Care Med 1999, 27: 1577-1581. 10.1097/00003246-199908000-00030CrossRefPubMed
41.
Zurück zum Zitat Cusack RJ, Rhodes A, Lochhead P, Jordan B, Perry S, Ball JAS, Grounds RM, Bennett ED: The strong ion gap does not have prognostic value in critically ill patients in a mixed medical/surgical adult ICU. Intensive Care Med 2002, 28: 864-869. 10.1007/s00134-002-1318-2CrossRefPubMed Cusack RJ, Rhodes A, Lochhead P, Jordan B, Perry S, Ball JAS, Grounds RM, Bennett ED: The strong ion gap does not have prognostic value in critically ill patients in a mixed medical/surgical adult ICU. Intensive Care Med 2002, 28: 864-869. 10.1007/s00134-002-1318-2CrossRefPubMed
42.
Zurück zum Zitat Rocktaschel J, Morimatsu H, Uchino S, Bellomo R: Unmeasured anions in critically ill patients: can they predict mortality? Crit Care Med 2003, 31: 2131-2136. 10.1097/01.CCM.0000079819.27515.8ECrossRef Rocktaschel J, Morimatsu H, Uchino S, Bellomo R: Unmeasured anions in critically ill patients: can they predict mortality? Crit Care Med 2003, 31: 2131-2136. 10.1097/01.CCM.0000079819.27515.8ECrossRef
43.
Zurück zum Zitat Kellum JA, Bellomo R, Kramer DJ, Pinsky MR: Etiology of metabolic acidosis during saline resuscitation in endotoxemia. Shock 1998, 9: 364-368.CrossRefPubMed Kellum JA, Bellomo R, Kramer DJ, Pinsky MR: Etiology of metabolic acidosis during saline resuscitation in endotoxemia. Shock 1998, 9: 364-368.CrossRefPubMed
44.
Zurück zum Zitat Kaplan L, Kellum JA: Initial pH, base deficit, lactate, anion gap, strong ion difference, and strong ion gap predict outcome from major vascular injury. Crit Care Med 2004, 32: 1120-1124. 10.1097/01.CCM.0000125517.28517.74CrossRefPubMed Kaplan L, Kellum JA: Initial pH, base deficit, lactate, anion gap, strong ion difference, and strong ion gap predict outcome from major vascular injury. Crit Care Med 2004, 32: 1120-1124. 10.1097/01.CCM.0000125517.28517.74CrossRefPubMed
45.
Zurück zum Zitat Dondorp AM, Chau TT, Phu NH, Mai NT, Loc PP, Chuong LV, Sinh DX, Taylor A, Hien TT, White NJ, Day NP: Unidentified acids of strong prognostic significance in severe malaria. Crit Care Med 2004, 32: 1683-1688. 10.1097/01.CCM.0000132901.86681.CACrossRefPubMed Dondorp AM, Chau TT, Phu NH, Mai NT, Loc PP, Chuong LV, Sinh DX, Taylor A, Hien TT, White NJ, Day NP: Unidentified acids of strong prognostic significance in severe malaria. Crit Care Med 2004, 32: 1683-1688. 10.1097/01.CCM.0000132901.86681.CACrossRefPubMed
47.
Zurück zum Zitat Hayhoe M, Bellomo R, Liu G, McNicol L, Buxton B: The aetiology and pathogenesis of cardiopulmonary bypass-associated metabolic acidosis using polygeline pump prime. Intensive Care Med 1999, 25: 680-685. 10.1007/s001340050930CrossRefPubMed Hayhoe M, Bellomo R, Liu G, McNicol L, Buxton B: The aetiology and pathogenesis of cardiopulmonary bypass-associated metabolic acidosis using polygeline pump prime. Intensive Care Med 1999, 25: 680-685. 10.1007/s001340050930CrossRefPubMed
48.
Zurück zum Zitat Durward A, Tibby SM, Skellett S, Austin C, Anderson D, Murdoch IA: The strong ion gap predicts mortality in children following cardiopulmonary bypass surgery. Pediatr Crit Care Med 2005, 6: 281-285. 10.1097/01.PCC.0000163979.33774.89CrossRefPubMed Durward A, Tibby SM, Skellett S, Austin C, Anderson D, Murdoch IA: The strong ion gap predicts mortality in children following cardiopulmonary bypass surgery. Pediatr Crit Care Med 2005, 6: 281-285. 10.1097/01.PCC.0000163979.33774.89CrossRefPubMed
49.
Zurück zum Zitat Rocktaschel J, Morimatsu H, Uchino S, Goldsmith D, Poustie S, Story D, Gutteridge G, Bellomo R: Acid-base status of critically ill patients with acute renal failure: analysis based on Stewart-Figge methodology. Crit Care 2003, 7: R60-R66. 10.1186/cc2333CrossRef Rocktaschel J, Morimatsu H, Uchino S, Goldsmith D, Poustie S, Story D, Gutteridge G, Bellomo R: Acid-base status of critically ill patients with acute renal failure: analysis based on Stewart-Figge methodology. Crit Care 2003, 7: R60-R66. 10.1186/cc2333CrossRef
50.
Zurück zum Zitat Kellum JA, Kramer DJ, Lee K, Mankad S, Bellomo R, Pinsky MR: Release of lactate by the lung in acute lung injury. Chest 1997, 111: 1301-1305.CrossRefPubMed Kellum JA, Kramer DJ, Lee K, Mankad S, Bellomo R, Pinsky MR: Release of lactate by the lung in acute lung injury. Chest 1997, 111: 1301-1305.CrossRefPubMed
51.
Zurück zum Zitat Morgan TJ, Venkatesh B, Hall J: Crystalloid strong ion difference determines metabolic acid-base change during in vitro hemodilution. Crit Care Med 2002, 30: 157-160. 10.1097/00003246-200201000-00022CrossRefPubMed Morgan TJ, Venkatesh B, Hall J: Crystalloid strong ion difference determines metabolic acid-base change during in vitro hemodilution. Crit Care Med 2002, 30: 157-160. 10.1097/00003246-200201000-00022CrossRefPubMed
Metadaten
Titel
Clinical review: Reunification of acid–base physiology
verfasst von
John A Kellum
Publikationsdatum
01.10.2005
Verlag
BioMed Central
Erschienen in
Critical Care / Ausgabe 5/2005
Elektronische ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc3789

Weitere Artikel der Ausgabe 5/2005

Critical Care 5/2005 Zur Ausgabe

Delir bei kritisch Kranken – Antipsychotika versus Placebo

16.05.2024 Delir Nachrichten

Um die Langzeitfolgen eines Delirs bei kritisch Kranken zu mildern, wird vielerorts auf eine Akuttherapie mit Antipsychotika gesetzt. Eine US-amerikanische Forschungsgruppe äußert jetzt erhebliche Vorbehalte gegen dieses Vorgehen. Denn es gibt neue Daten zum Langzeiteffekt von Haloperidol bzw. Ziprasidon versus Placebo.

Eingreifen von Umstehenden rettet vor Erstickungstod

15.05.2024 Fremdkörperaspiration Nachrichten

Wer sich an einem Essensrest verschluckt und um Luft ringt, benötigt vor allem rasche Hilfe. Dass Umstehende nur in jedem zweiten Erstickungsnotfall bereit waren, diese zu leisten, ist das ernüchternde Ergebnis einer Beobachtungsstudie aus Japan. Doch es gibt auch eine gute Nachricht.

Darf man die Behandlung eines Neonazis ablehnen?

08.05.2024 Gesellschaft Nachrichten

In einer Leseranfrage in der Zeitschrift Journal of the American Academy of Dermatology möchte ein anonymer Dermatologe bzw. eine anonyme Dermatologin wissen, ob er oder sie einen Patienten behandeln muss, der eine rassistische Tätowierung trägt.

Ein Drittel der jungen Ärztinnen und Ärzte erwägt abzuwandern

07.05.2024 Klinik aktuell Nachrichten

Extreme Arbeitsverdichtung und kaum Supervision: Dr. Andrea Martini, Sprecherin des Bündnisses Junge Ärztinnen und Ärzte (BJÄ) über den Frust des ärztlichen Nachwuchses und die Vorteile des Rucksack-Modells.

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.