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Facing acid-base disorders in the third millennium - the Stewart approach revisited.

Kishen R, Honoré PM, Jacobs R, Joannes-Boyau O, De Waele E, De Regt J, Van Gorp V, Boer W, Spapen H - Int J Nephrol Renovasc Dis (2014)

Bottom Line: Unfortunately, clinicians tend to think about an acid-base disturbance as a "disease" and spend long hours effectively treating numbers rather than the patient.Inappropriate interpretation may also lead to wrong clinical conclusions and incorrectly influence clinical management (eg, bicarbonate therapy for metabolic acidosis in different clinical situations).However, as the concept does not attach importance to plasma bicarbonate, clinicians may find it complicated to use in their daily clinical practice.

View Article: PubMed Central - PubMed

Affiliation: Intensive Care Unit, Salford Royal Hospitals NHS Trust, Salford, Manchester, UK (formerly) ; Translational Medicine and Neurosciences, University of Manchester, Manchester, UK.

ABSTRACT
Acid-base disorders are common in the critically ill. Most of these disorders do not cause harm and are self-limiting after appropriate resuscitation and management. Unfortunately, clinicians tend to think about an acid-base disturbance as a "disease" and spend long hours effectively treating numbers rather than the patient. Moreover, a sizable number of intensive-care physicians experience difficulties in interpreting the significance of or understanding the etiology of certain forms of acid-base disequilibria. Traditional tools for interpreting acid-base disorders may not be adequate for analyzing the complex nature of these metabolic abnormalities. Inappropriate interpretation may also lead to wrong clinical conclusions and incorrectly influence clinical management (eg, bicarbonate therapy for metabolic acidosis in different clinical situations). The Stewart approach, based on physicochemical principles, is a robust physiological concept that can facilitate the interpretation and analysis of simple, mixed, and complex acid-base disorders, thereby allowing better diagnosis of the cause of the disturbance and more timely treatment. However, as the concept does not attach importance to plasma bicarbonate, clinicians may find it complicated to use in their daily clinical practice. This article reviews various approaches to interpreting acid-base disorders and suggests the integration of base-excess and Stewart approach for a better interpretation of these metabolic disorders.

No MeSH data available.


Related in: MedlinePlus

Strong ion difference (SID) and plasma electroneutrality.Abbreviations: alb, albumin; UA, unmeasured anion; Pi, phosphates.
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f1-ijnrd-7-209: Strong ion difference (SID) and plasma electroneutrality.Abbreviations: alb, albumin; UA, unmeasured anion; Pi, phosphates.

Mentions: Simple formulae that do not need computers or calculators have been devised to make the Stewartapproach accessible in daily clinical practice. Evaluations of the SID and the ATOTeffect on BE (actually the SBE) are the most user-friendly clinical tools. They not only enable oneto unmask and quantify an ongoing acid–base abnormality but also help to establish theprobable cause. Applying a combined Stewart and BE approach necessitates routine withdrawal ofarterial blood gases (ABGs) and basic biochemical variables (ie, Na+,Cl−, albumin, PO4−). As K+,Ca++, and Mg++ only marginally contribute to the total sum of cations, SID, insimplified form, is best estimated as the difference between Na+ andCl− (and lactate, if elevated) (Figure1). The following simple calculations can then be applied:


Facing acid-base disorders in the third millennium - the Stewart approach revisited.

Kishen R, Honoré PM, Jacobs R, Joannes-Boyau O, De Waele E, De Regt J, Van Gorp V, Boer W, Spapen H - Int J Nephrol Renovasc Dis (2014)

Strong ion difference (SID) and plasma electroneutrality.Abbreviations: alb, albumin; UA, unmeasured anion; Pi, phosphates.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4060884&req=5

f1-ijnrd-7-209: Strong ion difference (SID) and plasma electroneutrality.Abbreviations: alb, albumin; UA, unmeasured anion; Pi, phosphates.
Mentions: Simple formulae that do not need computers or calculators have been devised to make the Stewartapproach accessible in daily clinical practice. Evaluations of the SID and the ATOTeffect on BE (actually the SBE) are the most user-friendly clinical tools. They not only enable oneto unmask and quantify an ongoing acid–base abnormality but also help to establish theprobable cause. Applying a combined Stewart and BE approach necessitates routine withdrawal ofarterial blood gases (ABGs) and basic biochemical variables (ie, Na+,Cl−, albumin, PO4−). As K+,Ca++, and Mg++ only marginally contribute to the total sum of cations, SID, insimplified form, is best estimated as the difference between Na+ andCl− (and lactate, if elevated) (Figure1). The following simple calculations can then be applied:

Bottom Line: Unfortunately, clinicians tend to think about an acid-base disturbance as a "disease" and spend long hours effectively treating numbers rather than the patient.Inappropriate interpretation may also lead to wrong clinical conclusions and incorrectly influence clinical management (eg, bicarbonate therapy for metabolic acidosis in different clinical situations).However, as the concept does not attach importance to plasma bicarbonate, clinicians may find it complicated to use in their daily clinical practice.

View Article: PubMed Central - PubMed

Affiliation: Intensive Care Unit, Salford Royal Hospitals NHS Trust, Salford, Manchester, UK (formerly) ; Translational Medicine and Neurosciences, University of Manchester, Manchester, UK.

ABSTRACT
Acid-base disorders are common in the critically ill. Most of these disorders do not cause harm and are self-limiting after appropriate resuscitation and management. Unfortunately, clinicians tend to think about an acid-base disturbance as a "disease" and spend long hours effectively treating numbers rather than the patient. Moreover, a sizable number of intensive-care physicians experience difficulties in interpreting the significance of or understanding the etiology of certain forms of acid-base disequilibria. Traditional tools for interpreting acid-base disorders may not be adequate for analyzing the complex nature of these metabolic abnormalities. Inappropriate interpretation may also lead to wrong clinical conclusions and incorrectly influence clinical management (eg, bicarbonate therapy for metabolic acidosis in different clinical situations). The Stewart approach, based on physicochemical principles, is a robust physiological concept that can facilitate the interpretation and analysis of simple, mixed, and complex acid-base disorders, thereby allowing better diagnosis of the cause of the disturbance and more timely treatment. However, as the concept does not attach importance to plasma bicarbonate, clinicians may find it complicated to use in their daily clinical practice. This article reviews various approaches to interpreting acid-base disorders and suggests the integration of base-excess and Stewart approach for a better interpretation of these metabolic disorders.

No MeSH data available.


Related in: MedlinePlus