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Acid-Base Balance: Common Sense Approach

Acid-Base Balance: Common Sense Approach Abstract Currently, there is an unprecedented interest in acid-base problems and several new approaches have been recommended.1-4 However, the only serious challenge to the supremacy long enjoyed by the traditional methods is offered by the system of Astrup and his associates.2-5 For a complete review of this controversy the reader is referred to the recent symposium sponsored by the New York Academy of Science.6 It should be emphasized that either the Astrup system or the traditional approach can be used with excellent results if the clinician is experienced with the method in question and understands the pathophysiology of the disease state with which he is dealing. Equal emphasis should be placed on the truism that in order to evaluate an acid-base disorder by either approach, one must be familiar with the compensatory changes which occur as the result of a given primary disturbance. A common misconception is that References 1. Singer, R.B., and Hastings, A.B.: An Improved Method for the Estimation of Disturbances of the Acid-Base Balance of Human Blood , Medicine 27:223, 1948.Crossref 2. Astrup, P., et al: The Acid-Base Metabolism: A New Approach , Lancet 1:1035, 1960.Crossref 3. Peirce, E.C., II: Simplified Approach to Obtaining and Recording Acid-Base Information in Surgical Patients , Ann Surg 156:138, 1962.Crossref 4. Owne, J.A.; Dudley, H.A.F.; and Masterton, J.P.: Acid-Base Status Assessed from Measurements of Hydrogen-Ion Concentration and Pco2 , Lancet 2:660, 1965.Crossref 5. Siggaard-Anderson, O.: The Acid-Base Status of the Blood , ed 2, Baltimore: The Williams & Wilkins Company, 1964. 6. Nahas, G.G. (ed.): Current Concepts of Acid-Base Measurements , Ann NY Acad Sci 133:1, 1966. 7. Astrup, P.: Acid-Base Disorders , New Eng J Med 269:817, 1963. 8. Schwartz, W.B., and Relman, A.S.: A Critique of the Parameters Used in the Evaluation of Acid-Base Disorders , New Eng J Med 268:1382, 1963.Crossref 9. Austin, W.H.: Acid-Base Balance: A Review of Current Approaches and Techniques , Amer Heart J 69:691, 1965.Crossref 10. Gambino, S.R.: Choice of Blood for Acid-Base Studies , Lancet 1:726, 1964.Crossref 11. Campbell, E.J.M., and Howell, J.B.L.: " The Determination of Mixed Venous and Arterial CO2 Tension by Rebreathing Techniques ," in Woolmer, R.F. (ed): pH and Blood Gas Measurements , Boston: Little Brown & Company, 1959, p 102. 12. Bergofsky, E.H.; Jacobson, J.H.; and Fishman, A.P.: The Use of Lymph for the Measurement of Gas Tensions in Interstitial Fluid and Tissues , J Clin Invest 41:1971, 1962.Crossref 13. Blumentals, A.; Eichenholz, A.; and Mulhausen, R.O.: Acid-Base Equilibrium in Arterial Blood and Ascitic Fluid , Metabolism 15:414, 1966.Crossref 14. Stinebaugh, B.J., and Austin, W.H.: Acid-Base Balance: A Pattern-Analysis Diagram , New Eng J Med 275:375, 1966.Crossref 15. Poppell, J.W., et al: The Effect of Ventilatory Insufficiency on Respiratory Compensations in Metabolic Acidosis and Alkalosis , J Lab Clin Med 47:885, 1956. 16. Elkington, J.R.: Clinical Disorders of Acid-Base Regulation , Med Clin N Amer 50:1325, 1966. 17. Lennon, E.J., and Lemann, J., Jr.: Defense of Hydrogen Ion Concentration in Chronic Metabolic Acidosis , Ann Intern Med 65:265 ( (Aug) ) 1966.Crossref 18. Austin, W.H.: Letters to the Editor , Amer Heart J 70:435, 1965.Crossref 19. Moller, P.: The Hydrogen Ion Concentration in Arterial Blood: A Clinical Study of Patients with Diabetes Mellitus and Diseases of the Kidneys, Lungs and Heart , Acta Med Scand 165 ( (suppl 348) ):1, 1959. 20. Refsun, H.E.: Acid-Base Status in Patients With Chronic Hypercapnia and Hypoxemia , Clin Sci 27:407, 1964. 21. Robin, E.D.: Abnormalities of Acid-Base Regulation in Chronic Pulmonary Disease with Special Reference to Hypercapnia and Extracellular Alkalosis , New Eng J Med 268:917, 1963.Crossref 22. Dulfano, M.T., and Ishikawa, S.: Quantitative Acid-Base Relationships in Chronic Pulmonary Patients During the Stable State , Amer Rev Resp Dis 93:251, 1966. 23. van Ypersele de Strihou, C.; Brasseur, L.; and De Coninck, J.: The Carbon Dioxide Response Curve for Chronic Hypercapnia in Man , New Eng J Med 275:117, 1966.Crossref 24. Rodriguez, B., et al: In Vivo Titration of Acute Alkali Infusions in Man , Clin Res 14:369, 1966. 25. Brackett, N.C., Jr.; Cohen, J.J.; and Schwartz, W.S.: Carbon Dioxide Titration Curve of Normal Man , New Eng J Med 268:917, 1963.Crossref 26. Schwartz, W.B.; Brackett, N.C., Jr.; and Cohen, J.J.: The Response of Extracellular Hydrogen Ion Concentration to Graded Degree of Chronic Hypercapnia: The Physiologic Limits of Defense of pH , J Clin Invest 144:291, 1965.Crossref 27. Schwartz, W.B., et al: Effects of Chronic Hypercapnia on Electrolyte and Acid-Base Equilibrium: II. Recovery With Special Reference to Influence of Chloride Intake , J Clin Invest 40:1238, 1961.Crossref 28. Murray, J.F.: Carbon Dioxide Retention without Acidosis: A Common Occurrence Due to Coexisting Potassium Deficiency, abstracted , Amer Rev Resp Dis 86:126, 1962. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Acid-Base Balance: Common Sense Approach

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American Medical Association
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Copyright © 1967 American Medical Association. All Rights Reserved.
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0003-9926
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1538-3679
DOI
10.1001/archinte.1967.00290200106009
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Abstract

Abstract Currently, there is an unprecedented interest in acid-base problems and several new approaches have been recommended.1-4 However, the only serious challenge to the supremacy long enjoyed by the traditional methods is offered by the system of Astrup and his associates.2-5 For a complete review of this controversy the reader is referred to the recent symposium sponsored by the New York Academy of Science.6 It should be emphasized that either the Astrup system or the traditional approach can be used with excellent results if the clinician is experienced with the method in question and understands the pathophysiology of the disease state with which he is dealing. Equal emphasis should be placed on the truism that in order to evaluate an acid-base disorder by either approach, one must be familiar with the compensatory changes which occur as the result of a given primary disturbance. A common misconception is that References 1. Singer, R.B., and Hastings, A.B.: An Improved Method for the Estimation of Disturbances of the Acid-Base Balance of Human Blood , Medicine 27:223, 1948.Crossref 2. Astrup, P., et al: The Acid-Base Metabolism: A New Approach , Lancet 1:1035, 1960.Crossref 3. Peirce, E.C., II: Simplified Approach to Obtaining and Recording Acid-Base Information in Surgical Patients , Ann Surg 156:138, 1962.Crossref 4. Owne, J.A.; Dudley, H.A.F.; and Masterton, J.P.: Acid-Base Status Assessed from Measurements of Hydrogen-Ion Concentration and Pco2 , Lancet 2:660, 1965.Crossref 5. Siggaard-Anderson, O.: The Acid-Base Status of the Blood , ed 2, Baltimore: The Williams & Wilkins Company, 1964. 6. Nahas, G.G. (ed.): Current Concepts of Acid-Base Measurements , Ann NY Acad Sci 133:1, 1966. 7. Astrup, P.: Acid-Base Disorders , New Eng J Med 269:817, 1963. 8. Schwartz, W.B., and Relman, A.S.: A Critique of the Parameters Used in the Evaluation of Acid-Base Disorders , New Eng J Med 268:1382, 1963.Crossref 9. Austin, W.H.: Acid-Base Balance: A Review of Current Approaches and Techniques , Amer Heart J 69:691, 1965.Crossref 10. Gambino, S.R.: Choice of Blood for Acid-Base Studies , Lancet 1:726, 1964.Crossref 11. Campbell, E.J.M., and Howell, J.B.L.: " The Determination of Mixed Venous and Arterial CO2 Tension by Rebreathing Techniques ," in Woolmer, R.F. (ed): pH and Blood Gas Measurements , Boston: Little Brown & Company, 1959, p 102. 12. Bergofsky, E.H.; Jacobson, J.H.; and Fishman, A.P.: The Use of Lymph for the Measurement of Gas Tensions in Interstitial Fluid and Tissues , J Clin Invest 41:1971, 1962.Crossref 13. Blumentals, A.; Eichenholz, A.; and Mulhausen, R.O.: Acid-Base Equilibrium in Arterial Blood and Ascitic Fluid , Metabolism 15:414, 1966.Crossref 14. Stinebaugh, B.J., and Austin, W.H.: Acid-Base Balance: A Pattern-Analysis Diagram , New Eng J Med 275:375, 1966.Crossref 15. Poppell, J.W., et al: The Effect of Ventilatory Insufficiency on Respiratory Compensations in Metabolic Acidosis and Alkalosis , J Lab Clin Med 47:885, 1956. 16. Elkington, J.R.: Clinical Disorders of Acid-Base Regulation , Med Clin N Amer 50:1325, 1966. 17. Lennon, E.J., and Lemann, J., Jr.: Defense of Hydrogen Ion Concentration in Chronic Metabolic Acidosis , Ann Intern Med 65:265 ( (Aug) ) 1966.Crossref 18. Austin, W.H.: Letters to the Editor , Amer Heart J 70:435, 1965.Crossref 19. Moller, P.: The Hydrogen Ion Concentration in Arterial Blood: A Clinical Study of Patients with Diabetes Mellitus and Diseases of the Kidneys, Lungs and Heart , Acta Med Scand 165 ( (suppl 348) ):1, 1959. 20. Refsun, H.E.: Acid-Base Status in Patients With Chronic Hypercapnia and Hypoxemia , Clin Sci 27:407, 1964. 21. Robin, E.D.: Abnormalities of Acid-Base Regulation in Chronic Pulmonary Disease with Special Reference to Hypercapnia and Extracellular Alkalosis , New Eng J Med 268:917, 1963.Crossref 22. Dulfano, M.T., and Ishikawa, S.: Quantitative Acid-Base Relationships in Chronic Pulmonary Patients During the Stable State , Amer Rev Resp Dis 93:251, 1966. 23. van Ypersele de Strihou, C.; Brasseur, L.; and De Coninck, J.: The Carbon Dioxide Response Curve for Chronic Hypercapnia in Man , New Eng J Med 275:117, 1966.Crossref 24. Rodriguez, B., et al: In Vivo Titration of Acute Alkali Infusions in Man , Clin Res 14:369, 1966. 25. Brackett, N.C., Jr.; Cohen, J.J.; and Schwartz, W.S.: Carbon Dioxide Titration Curve of Normal Man , New Eng J Med 268:917, 1963.Crossref 26. Schwartz, W.B.; Brackett, N.C., Jr.; and Cohen, J.J.: The Response of Extracellular Hydrogen Ion Concentration to Graded Degree of Chronic Hypercapnia: The Physiologic Limits of Defense of pH , J Clin Invest 144:291, 1965.Crossref 27. Schwartz, W.B., et al: Effects of Chronic Hypercapnia on Electrolyte and Acid-Base Equilibrium: II. Recovery With Special Reference to Influence of Chloride Intake , J Clin Invest 40:1238, 1961.Crossref 28. Murray, J.F.: Carbon Dioxide Retention without Acidosis: A Common Occurrence Due to Coexisting Potassium Deficiency, abstracted , Amer Rev Resp Dis 86:126, 1962.

Journal

Archives of Internal Medicine – American Medical Association

Published: Feb 1, 1967

References

  • An Improved Method for the Estimation of Disturbances of the Acid-Base Balance of Human Blood
    Singer , R.B., and Hastings, A.B.
  • The Acid-Base Metabolism: A New Approach
    Astrup , P., et al
  • Simplified Approach to Obtaining and Recording Acid-Base Information in Surgical Patients
    Peirce , E.C., II
  • Acid-Base Status Assessed from Measurements of Hydrogen-Ion Concentration and Pco2
    Owne , J.A.; Dudley, H.A.F.; and Masterton, J.P.
  • The Acid-Base Status of the Blood
    Siggaard-Anderson , O.
  • Current Concepts of Acid-Base Measurements
    Nahas , G.G. (ed.)
  • Acid-Base Disorders
    Astrup , P.
  • A Critique of the Parameters Used in the Evaluation of Acid-Base Disorders
    Schwartz , W.B., and Relman, A.S.
  • Acid-Base Balance: A Review of Current Approaches and Techniques
    Austin , W.H.
  • Choice of Blood for Acid-Base Studies
    Gambino , S.R.
  • pH and Blood Gas Measurements
    Campbell , E.J.M., and Howell, J.B.L.: "
  • The Use of Lymph for the Measurement of Gas Tensions in Interstitial Fluid and Tissues
    Bergofsky , E.H.; Jacobson, J.H.; and Fishman, A.P.
  • Acid-Base Equilibrium in Arterial Blood and Ascitic Fluid
    Blumentals , A.; Eichenholz, A.; and Mulhausen, R.O.
  • Acid-Base Balance: A Pattern-Analysis Diagram
    Stinebaugh , B.J., and Austin, W.H.
  • The Effect of Ventilatory Insufficiency on Respiratory Compensations in Metabolic Acidosis and Alkalosis
    Poppell , J.W., et al
  • Clinical Disorders of Acid-Base Regulation
    Elkington , J.R.
  • Defense of Hydrogen Ion Concentration in Chronic Metabolic Acidosis
    Lennon , E.J., and Lemann, J., Jr.
  • Letters to the Editor
    Austin , W.H.
  • The Hydrogen Ion Concentration in Arterial Blood: A Clinical Study of Patients with Diabetes Mellitus and Diseases of the Kidneys, Lungs and Heart
    Moller , P.
  • Acid-Base Status in Patients With Chronic Hypercapnia and Hypoxemia
    Refsun , H.E.
  • Abnormalities of Acid-Base Regulation in Chronic Pulmonary Disease with Special Reference to Hypercapnia and Extracellular Alkalosis
    Robin , E.D.
  • Quantitative Acid-Base Relationships in Chronic Pulmonary Patients During the Stable State
    Dulfano , M.T., and Ishikawa, S.
  • The Carbon Dioxide Response Curve for Chronic Hypercapnia in Man
    van Ypersele de Strihou , C.; Brasseur, L.; and De Coninck, J.
  • In Vivo Titration of Acute Alkali Infusions in Man
    Rodriguez , B., et al
  • Carbon Dioxide Titration Curve of Normal Man
    Brackett , N.C., Jr.; Cohen, J.J.; and Schwartz, W.S.
  • The Response of Extracellular Hydrogen Ion Concentration to Graded Degree of Chronic Hypercapnia: The Physiologic Limits of Defense of pH
    Schwartz , W.B.; Brackett, N.C., Jr.; and Cohen, J.J.
  • Effects of Chronic Hypercapnia on Electrolyte and Acid-Base Equilibrium: II. Recovery With Special Reference to Influence of Chloride Intake
    Schwartz , W.B., et al
  • Carbon Dioxide Retention without Acidosis: A Common Occurrence Due to Coexisting Potassium Deficiency, abstracted
    Murray , J.F.