Strong ion difference: a new paradigm or new clothes for the Acid-base emperor
1Department of Critical Care Medicine, Flinders Medical Centre, Adelaide, SA lindsay.Worthley@flinders.edu.au Australia.
Summary
This review compares the metabolic component of acid-base balance using arterial blood bicarbonate and the strong ion difference. The strong ion difference offers a novel way to understand metabolic acid-base disturbances.
Area of Science:
- Physiology
- Biochemistry
Background:
- The Henderson-Hasselbalch equation traditionally classifies acid-base abnormalities into respiratory or metabolic components.
- Arterial blood bicarbonate (HCO(3)(-)) is a key, yet indirectly measured, component in this classification.
- Derived values like base excess have been used to assess the metabolic contribution.
Purpose of the Study:
- To review and compare the metabolic aspect of acid-base abnormalities.
- To assess arterial blood bicarbonate and the strong ion difference (SID).
Main Methods:
- Literature review of peer-reviewed articles from 1983-1999.
- MEDLINE search focusing on the 'strong ion difference'.
Main Results:
- The strong ion difference (SID) provides an alternative framework for analyzing acid-base balance based on the law of electroneutrality.
- SID, along with carbon dioxide (CO(2)) and non-volatile weak acids (A(TOT)), influences pH and bicarbonate concentration (HCO(3)(-)).
- While the body regulates pH via PaCO(2) and HCO(3)(-), SID is crucial for understanding metabolic disturbances, especially those linked to saline infusions.
Conclusions:
- Renal and respiratory systems primarily regulate acid-base homeostasis by adjusting the bicarbonate buffer pair (PCO(2) and HCO(3)(-)).
- Other body buffer systems adapt to changes in this primary pair.
- Maintaining electrical neutrality involves commensurate changes in cation concentration alongside bicarbonate shifts.
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