Abstract
An advanced understanding of acid–base physiology is as central to the practice of critical care medicine, as are an understanding of cardiac and pulmonary physiology. Intensivists spend much of their time managing problems related to fluids, electrolytes, and blood pH. Recent advances in the understanding of acid–base physiology have occurred as the result of the application of basic physical-chemical principles of aqueous solutions to blood plasma. This analysis has revealed three independent variables that regulate pH in blood plasma. These variables are carbon dioxide, relative electrolyte concentrations, and total weak acid concentrations. All changes in blood pH, in health and in disease, occur through changes in these three variables. Clinical implications for these findings are also discussed.
Highlights
Whereas most medical and surgical subspecialists concern themselves with a specific organ, region of the body, or disease process, practitioners of critical care are more often concerned with the interaction of various organs and disease states
Intensivists, and others called upon to care for critically ill patients in the intensive care unit, operating room, or emergency department, are expected to diagnose and manage complicated disorders of acid–base balance
This review provides a rather indepth examination of chemistry and physiology of acid– base balance in health and disease
Summary
Whereas most medical and surgical subspecialists concern themselves with a specific organ (eg nephrology), region of the body (eg cardiothoracic surgery), or disease process (eg infectious disease), practitioners of critical care are more often concerned with the interaction of various organs and disease states. Some ions are completely dissociated solution as complex as blood plasma, there are but three in water, for example, Na+, K+, Ca2+, Mg2+, and Cl– These independent variables that determine H+ concentration. For blood plasma, these between the sum of all strong cations and all strong three variables are pCO2, SID, and the total weak acid concentration (ATOT). Plot of pH versus strong ion difference (SID) For this plot, total weak acid concentration (ATOT) and partial carbon dioxide tension (pCO2) were held constant at 18 mmol/l and 40 mmHg, respectively. When Cl– (a strong anion) chloride administration or secondary to abnormalities in is lost without loss of a strong cation, the SID is increased chloride handling or related to movements of chloride from and the plasma H+ concentration is decreased.
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