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A simplified bedside approach to acid-base: Fluid physiology utilizing classical and physicochemical approaches


Hughes, R and Brain, MJ, A simplified bedside approach to acid-base: Fluid physiology utilizing classical and physicochemical approaches, Anaesthesia and Intensive Care Medicine, 14, (10) pp. 445-452. ISSN 1472-0299 (2013) [Non Refereed Article]

Copyright Statement

Copyright 2013 Elsevier

DOI: doi:10.1016/j.mpaic.2013.07.013


The quantitative physicochemical model of human acid-base physiology filled a void that had developed between clinical acid-base analysis and general fluid physiology. Established approaches centred on the Henderson-Hasselbach (HH) equation allow a satisfactory exploration of respiratory perturbations but do not fully elucidate mechanisms of common non-respiratory 'metabolic' components. Though useful at the bedside, commonly used 'rules of thumb' that classify disturbances based on quantification of bicarbonate relative to CO2 have also fostered a language that often misrepresents bicarbonate physiology. The physicochemical model is frequently perceived as too complex for bedside use, however a set of simplified screening questions based on Stewart's model can be utilized to aid acid-base interpretation. Examples using this approach are included in an online appendix. Emphasis is placed on understanding the consequences of hypoalbuminaemia, volume, tonicity and chloride derangements as these are common in the care of intensive care unit patients. Aetiologies of acid-base disturbances are well described elsewhere and are not repeated here. © 2013 Elsevier Ltd. All rights reserved.

Item Details

Item Type:Non Refereed Article
Research Division:Biomedical and Clinical Sciences
Research Group:Clinical sciences
Research Field:Intensive care
Objective Division:Health
Objective Group:Clinical health
Objective Field:Clinical health not elsewhere classified
UTAS Author:Brain, MJ (Dr Matthew Brain)
ID Code:88732
Year Published:2013
Deposited By:Medicine
Deposited On:2014-02-13
Last Modified:2014-09-02

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