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https://www.readbyqxmd.com/read/27410514/old-and-new-approaches-to-the-interpretation-of-acid-base-metabolism-starting-from-historical-data-applied-to-diabetic-acidosis
#1
Roberto Mioni, Alessandra Marega, Marco Lo Cicero, Domenico Montanaro
The approach to acid-base chemistry in medicine includes several methods. Currently, the two most popular procedures are derived from Stewart's studies and from the bicarbonate/BE-based classical formulation. Another method, unfortunately little known, follows the Kildeberg theory applied to acid-base titration. By using the data produced by Dana Atchley in 1933, regarding electrolytes and blood gas analysis applied to diabetes, we compared the three aforementioned methods, in order to highlight their strengths and their weaknesses...
July 13, 2016: Scandinavian Journal of Clinical and Laboratory Investigation
https://www.readbyqxmd.com/read/27319095/-kidney-fluid-and-acid-base-balance
#2
REVIEW
Naohiro Shioji, Masao Hayashi, Hiroshi Morimatsu
Kidneys play an important role to maintain human homeostasis. They contribute to maintain body fluid, electrolytes, and acid-base balance. Especially in fluid control, we, physicians can intervene body fluid balance using fluid resuscitation and diuretics. In recent years, one type of fluid resuscitation, hydroxyl ethyl starch has been extensively studied in the field of intensive care. Although their effects on fluid resuscitation are reasonable, serious complications such as kidney injury requiring renal replacement therapy occur frequently...
May 2016: Masui. the Japanese Journal of Anesthesiology
https://www.readbyqxmd.com/read/27312130/hyperchloremic-acidosis-is-associated-with-acute-kidney-injury-after-abdominal-surgery
#3
Yosuke Toyonaga, Mutsuhito Kikura
AIM: Hyperchloremic acidosis may have an important role as a precursor of acute kidney injury (AKI) in the hyperchloremic environment induced by chloride-rich fluids, but this remains unclear. We tested the hypothesis that hyperchloremic acidosis assessed by the Stewart approach is associated with postoperative AKI. METHODS: A historical cohort study was conducted in adult patients who had normal renal function preoperatively and required admission to the intensive care unit after elective abdominal surgery...
June 16, 2016: Nephrology
https://www.readbyqxmd.com/read/27252098/tissue-oxygenation-monitoring-as-a-guide-for-trauma-resuscitation
#4
Cathy Mitchell
Hypoperfusion is the most common event preceding the onset of multiple organ dysfunction syndrome during trauma resuscitation. Detecting subtle changes in perfusion is crucial to ensure adequate tissue oxygenation and perfusion. Traditional methods of detecting physiological changes include measurements of blood pressure, heart rate, urine output, serum levels of lactate, mixed venous oxygen saturation, and central venous oxygen saturation. Continuous noninvasive monitoring of tissue oxygen saturation in muscle has the potential to indicate severity of shock, detect occult hypoperfusion, guide resuscitation, and be predictive of the need for interventions to prevent multiple organ dysfunction syndrome...
June 2016: Critical Care Nurse
https://www.readbyqxmd.com/read/27000203/an-acid-base-disorders-analysis-with-the-use-of-the-stewart-approach-in-patients-with-sepsis-treated-in-an-intensive-care-unit
#5
Jakub Szrama, Piotr Smuszkiewicz
BACKGROUND: Patients with sepsis admitted to the intensive care unit often present with acid-base disorders. As the traditional interpretation might be clinically misleading, an alternative approach described by Stewart may allow one to quantify the individual components of acid-base abnormalities and provide an insight into their pathogenesis. The aim of our study was to compare the traditional and Stewart approaches in the analysis of acid-base disturbance. METHODS: We analyzed arterial blood gases (ABG) taken from 43 ICU septic patients from admission to discharge categorising them according to SBE values...
2016: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/26475666/acid-base-disorders-associated-with-serum-electrolyte-patterns-in-patients-on-hemodiafiltration
#6
Jan Havlin, Otto Schück, Jiri Charvat, Krystof Slaby, Miroslava Horackova, Jan Klaboch, Michaela Sagova, Svetlana Vankova, Karel Matousovic
BACKGROUND: Metabolic acidosis (MAC) is a common aspect of dialysis-dependent patients. It is definitely caused by acid retention; however, the influence of other plasma ions is unclear. Understanding the mechanism of MAC and its correction is important when choosing the dialysis solution. Therefore, we assessed the relationship between intradialytic change of acid-base status and serum electrolytes. METHODS: We studied 68 patients on post-dilution hemodiafiltration, using dialysate bicarbonate concentration 32mmol/L...
December 2015: Néphrologie & Thérapeutique
https://www.readbyqxmd.com/read/26410149/understanding-acid-base-disorders
#7
REVIEW
Hernando Gomez, John A Kellum
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...
October 2015: Critical Care Clinics
https://www.readbyqxmd.com/read/26143339/assessment-of-acid-base-balance-stewart-s-approach
#8
B Fores-Novales, P Diez-Fores, L J Aguilera-Celorrio
The study of acid-base equilibrium, its regulation and its interpretation have been a source of debate since the beginning of 20th century. Most accepted and commonly used analyses are based on pH, a notion first introduced by Sorensen in 1909, and on the Henderson-Hasselbalch equation (1916). Since then new concepts have been development in order to complete and make easier the understanding of acid-base disorders. In the early 1980's Peter Stewart brought the traditional interpretation of acid-base disturbances into question and proposed a new method...
April 2016: Revista Española de Anestesiología y Reanimación
https://www.readbyqxmd.com/read/25685724/has-stewart-approach-improved-our-ability-to-diagnose-acid-base-disorders-in-critically-ill-patients
#9
REVIEW
Fabio D Masevicius, Arnaldo Dubin
The Stewart approach-the application of basic physical-chemical principles of aqueous solutions to blood-is an appealing method for analyzing acid-base disorders. These principles mainly dictate that pH is determined by three independent variables, which change primarily and independently of one other. In blood plasma in vivo these variables are: (1) the PCO2; (2) the strong ion difference (SID)-the difference between the sums of all the strong (i.e., fully dissociated, chemically nonreacting) cations and all the strong anions; and (3) the nonvolatile weak acids (Atot)...
February 4, 2015: World Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/25669331/the-assessment-of-acid-base-analysis-comparison-of-the-traditional-and-the-modern-approaches
#10
Jasna Todorović, Jelena Nešovic-Ostojić, Aleksandar Milovanović, Predrag Brkić, Mihailo Ille, Dušan Čemerikić
Three distinct approaches are currently used in assessing acid-base disorders: the traditional - physiological or bicarbonate-centered approach, the base-excess approach, and the "modern" physicochemical approach proposed by Peter Stewart, which uses the strong ion difference (particularly the sodium chloride difference) and the concentration of nonvolatile weak acids (particularly albumin) and partial pressure of carbon dioxide (pCO(2)) as independent variables in the assessment of acid-base status. The traditional approach developed from the pioneering work of Henderson and Hasselbalch and the base-excess are still most widely used in clinical practice, even though there are a number of problems identified with this approach...
February 2015: Medicinski Glasnik
https://www.readbyqxmd.com/read/25432555/effects-of-intravenous-solutions-on-acid-base-equilibrium-from-crystalloids-to-colloids-and-blood-components
#11
REVIEW
Thomas Langer, Michele Ferrari, Luca Zazzeron, Luciano Gattinoni, Pietro Caironi
Intravenous fluid administration is a medical intervention performed worldwide on a daily basis. Nevertheless, only a few physicians are aware of the characteristics of intravenous fluids and their possible effects on plasma acid-base equilibrium. According to Stewart's theory, pH is independently regulated by three variables: partial pressure of carbon dioxide, strong ion difference (SID), and total amount of weak acids (ATOT). When fluids are infused, plasma SID and ATOT tend toward the SID and ATOT of the administered fluid...
November 2014: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/25310552/-assessment-of-metabolic-acidosis-in-critically-ill-patients-method-of-stewart-fencl-figge-versus-the-traditional-henderson-hasselbalch-approach
#12
Manuela Borges Gavaza Barbosa, Crésio de Aragão Dantas Alves, Hélio Queiroz Filho
BACKGROUND AND OBJECTIVES: To review strategies of assessment of metabolic acidosis giving emphasis to the of Stewart-Fencl-Figge method versus the traditional method of Henderson-Hasselbalch. CONTENTS: Metabolic acidosis is a common issue in critically ill patients, an important cause of myocardial contractility depression and sensible marker of impaired tissue oxygenation. Traditionally, is evaluated by the Henderson-Hasselbalch approach in which an arterial blood sample provides information about the presence and type of acid base disturbance...
December 2006: Revista Brasileira de Terapia Intensiva
https://www.readbyqxmd.com/read/25307980/electrolyte-shifts-across-the-artificial-lung-in-patients-on-extracorporeal-membrane-oxygenation-interdependence-between-partial-pressure-of-carbon-dioxide-and-strong-ion-difference
#13
Thomas Langer, Eleonora Scotti, Eleonora Carlesso, Alessandro Protti, Loredana Zani, Monica Chierichetti, Pietro Caironi, Luciano Gattinoni
PURPOSE: Partial pressure of carbon dioxide (PCO2), strong ion difference (SID), and total amount of weak acids independently regulate pH. When blood passes through an extracorporeal membrane lung, PCO2 decreases. Furthermore, changes in electrolytes, potentially affecting SID, were reported. We analyzed these phenomena according to Stewart's approach. METHODS: Couples of measurements of blood entering (venous) and leaving (arterial) the extracorporeal membrane lung were analyzed in 20 patients...
February 2015: Journal of Critical Care
https://www.readbyqxmd.com/read/25186080/evaluation-of-acid-base-disorders-in-dogs-and-cats-presenting-to-an-emergency-room-part-1-comparison-of-three-methods-of-acid-base-analysis
#14
Kate Hopper, Steven E Epstein, Philip H Kass, Matthew S Mellema
OBJECTIVE: To compare the diagnostic performance of the traditional approach to acid-base analysis with the Stewart approach and a semiquantitative approach. DESIGN: Prospective cohort study. SETTING: University teaching hospital. ANIMALS: A total number of 84 dogs and 14 cats presenting to a university teaching hospital emergency room. PROCEDURES: All dogs and cats in which venous blood samples for acid-base, lactate, and serum biochemical analysis were all collected within 60 minutes of each other, over a 5-month enrollment period...
September 2014: Journal of Veterinary Emergency and Critical Care
https://www.readbyqxmd.com/read/25180963/evaluation-of-acid-base-disorders-in-dogs-and-cats-presenting-to-an-emergency-room-part-2-comparison-of-anion-gap-strong-ion-gap-and-semiquantitative-analysis
#15
Kate Hopper, Steven E Epstein, Philip H Kass, Matthew S Mellema
OBJECTIVE: To compare the diagnostic performance of the anion gap (AG) with 2 physicochemical approaches to identify unmeasured anions. DESIGN: Prospective cohort study. SETTING: University teaching hospital. ANIMALS: Eighty-four dogs and 14 cats presenting to a university teaching hospital emergency room. INTERVENTIONS: All dogs and cats in which venous blood samples for acid-base, lactate, and serum biochemical analysis were all collected within 60 minutes of each other, over a 5-month enrollment period...
September 2014: Journal of Veterinary Emergency and Critical Care
https://www.readbyqxmd.com/read/24959091/facing-acid-base-disorders-in-the-third-millennium-the-stewart-approach-revisited
#16
REVIEW
R Kishen, Patrick M Honoré, R Jacobs, O Joannes-Boyau, E De Waele, J De Regt, V Van Gorp, W Boer, Hd Spapen
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...
2014: International Journal of Nephrology and Renovascular Disease
https://www.readbyqxmd.com/read/24526205/base-excess-strong-ion-difference-and-expected-compensations-as-simple-as-it-is
#17
REVIEW
Fernando Schiraldi, Giovanna Guiotto
The main purpose of this article is to provide some practical insights into acid-base disorders interpretation, comparing the three most widespread diagnostic approaches. After a brief summary of the history of blood gas analysis and the shift from a purely chemical approach to more clinically useful applications, the pros and cons of the different methodologies are compared and discussed. Reviewing the most important publications in the field, the authors attempt to show that each diagnostic strategy is acceptable, although the one based on base-excess calculation perhaps seems too 'rough' to understand the mixed disorders, whereas the Stewart approach is attractive from a chemical point of view, but unsuitable for the emergency physician because of the cumbersome calculations needed...
December 2014: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
https://www.readbyqxmd.com/read/24407901/acid-base-disorder-analysis-during-diabetic-ketoacidosis-using-the-stewart-approach-a-case-report
#18
COMPARATIVE STUDY
Jakub Szrama, Piotr Smuszkiewicz
This case report presents a 49 year-old female with type 1 diabetes admitted to the intensive care unit with acute respiratory failure and severe diabetic ketoacidosis with an initial measurement of blood glucose level of 1,200 mg L⁻¹, pH 6.78, serum HCO₃ ⁻ 3.2 mmoL L⁻¹ and BE -31.2 mmoL L⁻¹. Analysis of the blood gasometric parameters with the Stewart approach and the traditional Henderson-Hasselbalch concept enabled the discovery of metabolic acidosis caused by unidentified anions (mainly ketons)...
October 2013: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/24404459/evaluation-of-the-efficacy-of-simplified-fencl-stewart-equation-in-analyzing-the-changes-in-acid-base-status-following-resuscitation-with-two-different-fluids
#19
S Moied Ahmed, P Maheshwari, S Agarwal, Abu Nadeem, L Singh
BACKGROUND: Metabolic acid-base disorders in critically ill patients may not be identified by base excess (BE) approach. Anion gap method can detect approximately 1/3 hidden "gap acidosis". In such conditions, when adjusted for hypoalbuminemia, Fencl-Stewart's approach can reliably detect the hidden abnormal anions. AIM: Evaluate the efficacy of simplified Fencl-Stewart equation in identifying the changes in acid-base status of sepsis patients following resuscitation with two different fluids...
July 2013: International Journal of Critical Illness and Injury Science
https://www.readbyqxmd.com/read/24042153/evaluation-of-acid-base-status-in-brain-dead-donors-and-the-impact-of-metabolic-acidosis-on-organ-retrieval
#20
J H Lee, M S Kim, S Na, S O Koh, J Sim, Y S Choi
BACKGROUND: Pathophysiologic changes after brain death can lead to acid-base disturbances. The primary aim of this study was to clarify the acid-base state and its source in brain dead donors using Stewart's approach. Additionally, we investigated whether the presence of metabolic acidosis affected the number of organs retrieved from donors. METHODS: A retrospective review of electronic medical records was performed for brain dead donors who had undergone organ harvesting during the past 5 years in a tertiary medical center...
September 2013: Minerva Anestesiologica
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