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Acid-base pathophysiology after 130 years: confusing, irrational and controversial.

Kenrick Berend¹

¹Department of Internal Medicine and Nephrology, St. Elisabeth Hospital, Curacao, Netherlands Antilles. kberend@sehos.an

Journal of Nephrology

|September 15, 2012

Summary

Despite advances in acid-base physiology, confusion persists regarding acid-base balance and blood gas interpretation. This review identifies and suggests solutions for remaining controversies in acid-base disorders.

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Area of Science:

Physiology
Biochemistry
Medical Diagnostics

Background:

The study of acid-base balance has a long history, with significant progress made over 130 years.
Despite advancements, understanding of acid-base balance mechanisms remains incomplete.
Recent years have seen increased controversy in classifying and understanding acid-base derangements.

Purpose of the Study:

To analyze the medical literature on acid-base disorders.
To identify gaps in knowledge and controversial issues in acid-base assessment and management.
To provide suggestions for reducing confusion in the field.

Main Methods:

A comprehensive literature search was conducted using MEDLINE and EMBASE.
Internal medicine, critical care, and nephrology textbooks were reviewed.
Reference lists of relevant articles and texts were also searched.

Main Results:

Several confusing and controversial issues were identified concerning acid-base nomenclature.
Irrationalities in reference values, pathophysiology, and assessment of acid-base disorders were found.
Therapeutic controversies related to acid-base derangements were also noted.

Conclusions:

Significant progress in acid-base knowledge has been achieved.
However, numerous confusing, irrational, and controversial issues persist.
The study offers recommendations to clarify and resolve these ongoing debates.