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Acid-base pathophysiology after 130 years: confusing, irrational and controversial.

Abstract

BACKGROUND

The interface between acid-base physiology and blood gas interpretation is historically both stimulating and turbulent. Since the pioneering work of many celebrated names in the history of acid-base disorders, such as Arrhenius, Henderson, Hasselbalch and many more to follow, substantial progress in acid-base knowledge has been made over the last 130 years. Out of the chaos of competing definitions, concepts and terms, many have tried to bring an orderly approach to acid-base balance. Nevertheless, the mechanisms responsible for acid-base balance are unfortunately still incompletely understood, and moreover, considerable controversy has developed over the past decade as to how to classify and understand acid-base derangements occurring as a result of abnormalities in acid-base balance.

METHODS

Analysis of the medical literature, including a MEDLINE and EMBASE search, and a search of internal medicine, critical care and nephrology textbooks and reference lists, was performed on topics pertaining to the assessment and management of acid-base disorders, focusing on the gaps in our knowledge and on controversial issues.

RESULTS

Several confusing, irrational and controversial issues concerning acid-base nomenclature, reference values, pathophysiology, assessment of acid-base disorders and therapy were found.

CONCLUSIONS

Despite huge progress in acid-base knowledge, several confusing, irrational and controversial issues remain. Suggestions to reduce the confusion are provided.

Authors+Show Affiliations

Department of Internal Medicine and Nephrology, St. Elisabeth Hospital, Curacao, Netherlands Antilles. kberend@sehos.an

Source

Journal of nephrology 26:2 pg 254-65

MeSH

Acid-Base Equilibrium
Acid-Base Imbalance
Acidosis
Adolescent
Adult
Aged
Aged, 80 and over
Animals
Bicarbonates
Biomarkers
Blood Gas Analysis
Chlorides
Female
Fluid Therapy
Humans
Hydrogen-Ion Concentration
Lactic Acid
Male
Middle Aged
Reference Standards
Serum Albumin
Sodium Bicarbonate
Terminology as Topic
Young Adult

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

22976522

Citation

TY - JOUR T1 - Acid-base pathophysiology after 130 years: confusing, irrational and controversial. A1 - Berend,Kenrick, Y1 - 2012/09/13/ PY - 2012/05/14/accepted PY - 2012/9/15/entrez PY - 2012/9/15/pubmed PY - 2013/9/14/medline SP - 254 EP - 65 JF - Journal of nephrology JO - J. Nephrol. VL - 26 IS - 2 N2 - BACKGROUND: The interface between acid-base physiology and blood gas interpretation is historically both stimulating and turbulent. Since the pioneering work of many celebrated names in the history of acid-base disorders, such as Arrhenius, Henderson, Hasselbalch and many more to follow, substantial progress in acid-base knowledge has been made over the last 130 years. Out of the chaos of competing definitions, concepts and terms, many have tried to bring an orderly approach to acid-base balance. Nevertheless, the mechanisms responsible for acid-base balance are unfortunately still incompletely understood, and moreover, considerable controversy has developed over the past decade as to how to classify and understand acid-base derangements occurring as a result of abnormalities in acid-base balance. METHODS: Analysis of the medical literature, including a MEDLINE and EMBASE search, and a search of internal medicine, critical care and nephrology textbooks and reference lists, was performed on topics pertaining to the assessment and management of acid-base disorders, focusing on the gaps in our knowledge and on controversial issues. RESULTS: Several confusing, irrational and controversial issues concerning acid-base nomenclature, reference values, pathophysiology, assessment of acid-base disorders and therapy were found. CONCLUSIONS: Despite huge progress in acid-base knowledge, several confusing, irrational and controversial issues remain. Suggestions to reduce the confusion are provided. SN - 1724-6059 UR - https://www.unboundmedicine.com/medline/citation/22976522/Acid_base_pathophysiology_after_130_years:_confusing_irrational_and_controversial_ ER -