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Nutrition in Clinical Practice :... Oct 2022An understanding of acid-base physiology is necessary for clinicians to recognize and correct problems that may negatively affect provision of nutrition support and drug... (Review)
Review
An understanding of acid-base physiology is necessary for clinicians to recognize and correct problems that may negatively affect provision of nutrition support and drug therapy. An overview of acid-base physiology, the different acid-base disorders encountered in practice, a stepwise approach to evaluate arterial blood gases, and other key diagnostic tools helpful in formulating a safe and effective medical and nutrition plan are covered in this acid-base primer. Case scenarios are also provided for the application of principles and the development of clinical skills.
Topics: Acid-Base Equilibrium; Acid-Base Imbalance; Acidosis; Alkalosis; Alkalosis, Respiratory; Blood Gas Analysis; Humans; Hydrogen-Ion Concentration
PubMed: 35752932
DOI: 10.1002/ncp.10881 -
The New England Journal of Medicine Oct 2014
Review
Topics: Acid-Base Imbalance; Bicarbonates; Homeostasis; Humans; Hydrogen-Ion Concentration; Oxygen; Reference Values
PubMed: 25295502
DOI: 10.1056/NEJMra1003327 -
Seminars in Nephrology May 2013Acid-base balance and potassium disorders are often clinically linked. Importantly, acid-base disorders alter potassium transport. In general, acidosis causes decreased... (Review)
Review
Acid-base balance and potassium disorders are often clinically linked. Importantly, acid-base disorders alter potassium transport. In general, acidosis causes decreased K(+) secretion and increased reabsorption in the collecting duct. Alkalosis has the opposite effects, often leading to hypokalemia. Potassium disorders also influence acid-base homeostasis. Potassium depletion causes increased H(+) secretion, ammoniagenesis and H-K-ATPase activity. Hyperkalemia decreases ammoniagenesis and NH4(+) transport in the thick ascending limb. Some combined potassium and acid-base disorders involve indirect factors such as aldosterone, impaired renal function, volume depletion, and diarrhea. In summary, disorders of potassium and acid-base homeostasis are mechanistically linked and clinically important.
Topics: Acid-Base Equilibrium; Acid-Base Imbalance; Homeostasis; Humans; Hyperkalemia; Hypokalemia; Kidney Tubules; Potassium
PubMed: 23953803
DOI: 10.1016/j.semnephrol.2013.04.006 -
Journal of Hepatology Nov 2017Alongside the kidneys and lungs, the liver has been recognised as an important regulator of acid-base homeostasis. While respiratory alkalosis is the most common... (Review)
Review
Alongside the kidneys and lungs, the liver has been recognised as an important regulator of acid-base homeostasis. While respiratory alkalosis is the most common acid-base disorder in chronic liver disease, various complex metabolic acid-base disorders may occur with liver dysfunction. While the standard variables of acid-base equilibrium, such as pH and overall base excess, often fail to unmask the underlying cause of acid-base disorders, the physical-chemical acid-base model provides a more in-depth pathophysiological assessment for clinical judgement of acid-base disorders, in patients with liver diseases. Patients with stable chronic liver disease have several offsetting acidifying and alkalinising metabolic acid-base disorders. Hypoalbuminaemic alkalosis is counteracted by hyperchloraemic and dilutional acidosis, resulting in a normal overall base excess. When patients with liver cirrhosis become critically ill (e.g., because of sepsis or bleeding), this fragile equilibrium often tilts towards metabolic acidosis, which is attributed to lactic acidosis and acidosis due to a rise in unmeasured anions. Interestingly, even though patients with acute liver failure show significantly elevated lactate levels, often, no overt acid-base disorder can be found because of the offsetting hypoalbuminaemic alkalosis. In conclusion, patients with liver diseases may have multiple co-existing metabolic acid-base abnormalities. Thus, knowledge of the pathophysiological and diagnostic concepts of acid-base disturbances in patients with liver disease is critical for therapeutic decision making.
Topics: Acid-Base Imbalance; Critical Illness; Disease Progression; Humans; Liver Diseases; Liver Function Tests
PubMed: 28684104
DOI: 10.1016/j.jhep.2017.06.023 -
Critical Care Clinics Oct 2015The concentration of hydrogen ions is regulated in biologic solutions. There are currently 3 recognized approaches to assess changes in acid base status. First is the... (Review)
Review
The concentration of hydrogen ions is regulated in biologic solutions. There are currently 3 recognized approaches to assess changes in acid base status. First is the traditional Henderson-Hasselbalch approach, also called the physiologic approach, which uses the relationship between HCO3(-) and Pco2; the second is the standard base excess approach based on the Van Slyke equation. The third approach is the quantitative or Stewart approach, which uses the strong ion difference and the total weak acids. This article explores the origins of the current concepts framing the existing methods to analyze acid base balance.
Topics: Acid-Base Equilibrium; Acid-Base Imbalance; Buffers; Carbon Dioxide; Humans; Hydrogen-Ion Concentration; Mathematical Concepts; Partial Pressure; Plasma
PubMed: 26410149
DOI: 10.1016/j.ccc.2015.06.016 -
The Annals of Pharmacotherapy Jan 2024The objective of this review is to discuss acid-base physiology, describe the essential steps for interpreting an arterial blood gas and relevant laboratory tests, and... (Review)
Review
OBJECTIVE
The objective of this review is to discuss acid-base physiology, describe the essential steps for interpreting an arterial blood gas and relevant laboratory tests, and review the 4 distinct types of acid-base disorders.
DATA SOURCES
A comprehensive literature search and resultant bibliography review of PubMed from inception through March 7, 2023.
STUDY SELECTION AND DATA EXTRACTION
Relevant English-language articles were extracted and evaluated.
DATA SYNTHESIS
Critically ill patients are prone to significant acid-base disorders that can adversely affect clinical outcomes. Assessing these acid-base abnormalities can be complex because of dynamic aberrations in plasma proteins, electrolytes, extracellular volume, concomitant therapies, and use of mechanical ventilation. This article provides a systematic approach to acid-base abnormalities which is necessary to facilitate prompt identification of acid-base disturbances and prevent untoward morbidity and mortality.
RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE
Many acid-base disorders result from medication therapy or are treated with medications. Pharmacists are uniquely poised as the medication experts on the multidisciplinary team to assist with acid-base assessments in the context of pharmacotherapy.
CONCLUSION
The use of a systematic approach to address acid-base disorders can be performed by all pharmacists to improve pharmacotherapy and optimize patient outcomes.
Topics: Humans; Critical Illness; Respiration, Artificial; Critical Care; Pharmacists; Acid-Base Imbalance
PubMed: 37125739
DOI: 10.1177/10600280231165787 -
Revista Espanola de Anestesiologia Y... Jan 2020Abnormalities in the acid-base balance are common clinical problems and can have deleterious effects on cellular function and be a clue to various disorders. Therefore,... (Review)
Review
Abnormalities in the acid-base balance are common clinical problems and can have deleterious effects on cellular function and be a clue to various disorders. Therefore, it is important for the clinician to make a precise diagnosis of the acid-base disorder(s) present for a proper treatment. Three approaches have been proposed to evaluate acid-base disorders: a bicarbonate-centric approach; the Stewart approach, and the base excess approach. Although the latter two have many adherents, we will only discuss the bicarbonate-centric approach. This approach is simpler to utilize at the bedside, has a physiological evaluation of the acid-base disorder, presents an easily understandable approach to assess severity, and provides a more solid foundation for the development of effective therapies. Therefore, the following discussion will be limited to an examination of this approach. In this case-centric review, important new concepts will be introduced first; their benefits and limitations discussed; and then their utilization to analyze actual cases will be shown. A systematic approach algorithm that incorporates these new concepts has been generated and will be highlighted.
Topics: Acid-Base Equilibrium; Acid-Base Imbalance; Acidosis; Algorithms; Alkalosis; Bicarbonates; Blood Gas Analysis; Humans; Hydrogen-Ion Concentration; Reference Values
PubMed: 31826801
DOI: 10.1016/j.redar.2019.04.001 -
The Veterinary Clinics of North... Jan 2023In clinical medicine, evaluation of acid-base balance can be a valuable diagnostic and monitoring tool. Blood gas machines need very small volumes of blood and provide... (Review)
Review
In clinical medicine, evaluation of acid-base balance can be a valuable diagnostic and monitoring tool. Blood gas machines need very small volumes of blood and provide immediate results, making them ideal for use in the emergency room and intensive care setting. This review outlines the stepwise approach to assessment of acid-base balance in dogs, common causes of acid-base abnormalities, and the general approach to treatment.
Topics: Dogs; Animals; Acid-Base Imbalance; Alkalosis; Acid-Base Equilibrium; Blood Gas Analysis; Hydrogen-Ion Concentration; Dog Diseases
PubMed: 36270834
DOI: 10.1016/j.cvsm.2022.07.014 -
The New England Journal of Medicine Nov 2014
Review
Topics: Acid-Base Equilibrium; Acid-Base Imbalance; Adult; Aged; Bicarbonates; Electrolytes; Female; Humans; Hydrogen-Ion Concentration; Ions; Male; Models, Chemical
PubMed: 25372090
DOI: 10.1056/NEJMra1215672 -
Disease-a-month : DM Mar 2004Acid-base problem solving has been an integral part of medical practice in recent generations. Diseases discovered in the last 30-plus years, for example, Bartter... (Review)
Review
Acid-base problem solving has been an integral part of medical practice in recent generations. Diseases discovered in the last 30-plus years, for example, Bartter syndrome and Gitelman syndrome, D-lactic acidosis, and bulimia nervosa, can be diagnosed according to characteristic acid-base findings. Accuracy in acid-base problem solving is a direct result of a reproducible, systematic approach to arterial pH, partial pressure of carbon dioxide, bicarbonate concentration, and electrolytes. The 'Rules of Five' is one tool that enables clinicians to determine the cause of simple and complex disorders, even triple acid-base disturbances, with consistency. In addition, other electrolyte abnormalities that accompany acid-base disorders, such as hypokalemia, can be incorporated into algorithms that complement the Rules and contribute to efficient problem solving in a wide variety of diseases. Recently urine electrolytes have also assisted clinicians in further characterizing select disturbances. Acid-base patterns, in many ways, can serve as a 'common diagnostic pathway' shared by all subspecialties in medicine. From infectious disease (eg, lactic acidemia with highly active antiviral therapy therapy) through endocrinology (eg, Conn's syndrome, high urine chloride alkalemia) to the interface between primary care and psychiatry (eg, bulimia nervosa with multiple potential acid-base disturbances), acid-base problem solving is the key to unlocking otherwise unrelated diagnoses. Inasmuch as the Rules are clinical tools, they are applied throughout this monograph to diverse pathologic conditions typical in contemporary practice.
Topics: Acid-Base Equilibrium; Acid-Base Imbalance; Confusion; Feeding and Eating Disorders; Humans; Hypokalemia; Potassium; Psychomotor Agitation
PubMed: 15069420
DOI: 10.1016/j.disamonth.2004.01.002