Acid-base imbalance: a review with proposed unified diagnostic algorithm
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Keywords

Acid-base imbalance, blood gas analysis, diagnosis, algorithms.

How to Cite

1.
Correa Guerrero J, Rico Fontalvo J, Daza Arnedo R, Abuabara Franco E, Leal Martínez V, Pájaro Galvis NE, Cardona Blanco M, Monterrosa Robles M, Palomino Herrera J, Batista Lambis M, Garcerant Campo I, Castro Ahumada R, Perales Caballero K. Acid-base imbalance: a review with proposed unified diagnostic algorithm. Rev. Colomb. Nefrol. [Internet]. 2020 Aug. 4 [cited 2022 Jun. 25];7(2). Available from: https://revistanefrologia.org/index.php/rcn/article/view/497

Abstract

Introduction: Alterations in the acid-base balance are studied in all medical specialties. Although most cases derive from a preexisting pathology, they can also manifest themselves in a primary context. The proper identification of the acid-base disorder allows the pathological process to be characterized. The correct interpretation of the blood gasometry as a technique for monitoring the ventilatory status, oxygenation and acid-base balance of a patient requires the integration of various physicochemical approaches in order to specify a diagnosis, quantify a therapeutic response, and monitor the severity or the progression of a pathological process.

Methodology: A literature review was conducted in the PubMed, Scopus and Science Direct databases. The articles were selected according to the title and the abstract and sorted by topics relevant by pathophysiology, divergences, clinical approach, diagnosis, and management.

Results: A guide the clinical correlation of the critical patient with the blood gasometry parameters to characterize the acid-base disorder through the proposition of a diagnostic algorithm.

Conclusion: The incorporation of the three theories in a diagnostic algorithm facilitates a greater understanding of the pathophysiological mechanisms and allows us to identify a more precise therapeutic objective to correct the underlying disorder in the different clinical contexts of the patient.

https://doi.org/10.22265/acnef.7.2.497
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References

Fencl V, Rossing TH. Acid-Base Disorders in Critical Care Medicine. Annu Rev Med. 1989;40(1):17-29. https://dx.doi.org/10.1146/annurev.me.40.020189.000313.

Rocktaeschel J, Morimatsu H, Uchino S, Goldsmith D, Poustie S, Story D, et al. Acid-base status of critically ill patients with acute renal failure: analysis based on Stewart-Figge methodology. Crit Care. 2003;7(4):60-6. https://dx.doi.org/10.1186/cc2333.

Aristizábal-Salazar RE, Calvo-Torres LF, Valencia-Arango LA, Montoya-Cañon M, Barbosa-Gantiva O, Hincapié-Baena V. Acid-base equilibrium: The best clinical approach. Rev. Colomb. Anestesiol. 2015;43(3):219-24. https://dx.doi.org/10.1016/j.rcae.2015.05.002.

Dzierba AL, Abraham P. A practical approach to understanding acid-base abnormalities in critical illness. J Pharm Pract. 2011;24(1):17-26. https://dx.doi.org/10.1177/0897190010388153.

Palmer BF. Approach to Fluid and Electrolyte Disorders and Acid-Base Problems. Prim Care. 2008;35(2):195-213. https://dx.doi.org/10.1016/j.pop.2008.01.004.

Day J, Pandit JJ. Analysis of blood gases and acid-base balance. Surgery. 2011;29(3):107-11. https://dx.doi.org/10.1016/j.mpsur.2010.11.023.

Siggard?Andersen O, Fogh?Andersen N. Base excess or buffer base (strong ion difference) as measure of a non?respiratory acid?base disturbance. Acta Anaesthesiol Scand Suppl. 1995;107:123-8. https://dx.doi.org/10.1111/j.1399-6576.1995.tb04346.x.

Magder S, Emami A. Practical approach to physical-chemical acid-base management: Stewart at the bedside. Ann Am Thorac Soc. 2015;12(1):111-7. https://dx.doi.org/10.1513/AnnalsATS.201409-426OI.

Fores-Novales B, Diez-Fores P, Aguilera-Celorrio LJ. Evaluación del equilibrio ácido-base. Aportaciones del método de Stewart. Rev Esp Anestesiol Reanim. 2016;63(4):212-9. https://dx.doi.org/10.1016/j.redar.2015.04.004.

Oliver P, Rodríguez O, Marín JL, Muñoz M, Guillén E, Valcárcel G, et al. Estudio de la oxigenación e interpretación de la gasometría arterial. Documentos de la SEQC. 2015.

Williams AJ. ABC of oxygen: assessing and interpreting arterial blood gases and acid-base balance. BMJ. 1998;317(7167):1213-6. https://dx.doi.org/10.1136/bmj.317.7167.1213.

Hopkins E, Sanvictores T, Sharma S. Physiology, Acid Base Balance. In: StatPearls Treasure Island (FL): StatPearls Publishing; 2018.

Koeppen BM. The kidney and acid-base regulation. Adv Physiol Educ. 2009;33(4):275-81. https://dx.doi.org/10.1152/advan.00054.2009.

Prieto-de Paula JM, Franco-Hidalgo S, Mayor-Toranzo E, Palomino-Doza J, Prieto-de Paula JF. Alteraciones del equilibrio ácido-base. Dialisis y Trasplante. 2012;33(1):25-34. https://dx.doi.org/10.1016/j.dialis.2011.06.004.

Kamel KS. Diagnostic Use of Base Excess in Acid-Base Disorders. N Engl J Med. 2018;379(5):494-6. https://dx.doi.org/10.1056/ NEJMc1806372.

Greenbaum J, Nirmalan M. Acid - base balance?: The traditional approach. Curr Anaesth Crit Care. 2005;16(3):137-42. https://dx.doi.org/10.1016/j.cacc.2005.03.009.

Atherton JC. Role of the kidney in acid-base balance. Anaesth Intensive Care Med. 2015;16(6):275-7. https://dx.doi.org/10.1016/J.MPAIC.2015.03.002.

Hamilton PK, Morgan NA, Connolly GM, Maxwell AP. Understanding Acid-Base Disorders. Ulster Med J. 2017;86(3):161-6.

Paulev PE, Zubieta-Calleja GR. Essentials in the diagnosis of acid-base disorders and their high altitude application. J Physiol Pharmacol. 2005;56(Suppl 4):155-70.

Edwards SL. Pathophysiology of acid base balance: the theory practice relationship. Intensive Crit care Nurs. 2008;24(1):28-38. https://dx.doi.org/10.1016/j.iccn.2007.05.003.

Kurtz I. Renal Tubular Acidosis: H+/Base and Ammonia Transport Abnormalities and Clinical Syndromes. Adv Chronic Kidney Dis. 2018;25(4):334-50. https://dx.doi.org/10.1053/j.ackd.2018.05.005.

Kimura S, Shabsigh M, Morimatsu H. Traditional approach versus Stewart approach for acid-base disorders: Inconsistent evidence. SAGE Open Med. 2018;6:205031211880125. https://dx.doi.org/10.1177/2050312118801255.

Guidet B, Soni N, Rocca G, Kozek S, Vallet B, Annane D, et al. A balanced view of balanced solutions. Crit Care. 2010;14(5):325.https://dx.doi.org/10.1186/cc9230.

Sánchez-Díaz JS, Martínez-Rodríguez EA, Méndez-Rubio LP, Peniche-Moguel KG, Huanca-Pacaje JM, López-Guzmán C, et al. Equilibrio ácido-base. Puesta al día. Teoría de Henderson-Hasselbalch. Med Interna Mex. 2016;32(6):646-60.

Moe OW, Fuster D. Clinical acid-base pathophysiology: disorders of plasma anion gap. Best Pract Res Clin Endocrinol Metab. 2003;17(4):559-74. https://dx.doi.org/10.1016/s1521-690x(03)00054-x.

Figge J, Jabor A, Kazda A, Fencl V. Anion gap and hypoalbuminemia. Crit Care Med. 1998;26(11):1807-10. https://dx.doi.org/10.1097/00003246-199811000-00019.

Fencl V, Jabor A, Kazda A, Figge J. Diagnosis of Metabolic Acid - Base Disturbances in Critically Ill Patients. Crit Care Med. 2000;162(6):2246-51. https://dx.doi.org/10.1164/ajrccm.162.6.9904099.

Morgan TJ. The meaning of acid-base abnormalities in the intensive care unit: part III — effects of fluid administration. Crit Care. 2005;9(2):204-11. https://dx.doi.org/10.1186/cc2946.

Häubi SC, Moreno-Santillán A, de León-Ponce MD, Briones-Vega CG, Meneses-Calderón J, Orenday-Aréchiga ME, et al. Teoría ácido-básico de Stewart, un nuevo paradigma en medicina crítica. Rev Mex Anest. 2006;29(4):240-44.

Rastegar A. Clinical utility of Stewart’s method in diagnosis and management of acid-base disorders. Clin J Am Soc Nephrol. 2009;4(7):1267-74. https://dx.doi.org/10.2215/CJN.01820309.

Kishen R, Honoré PM, Jacobs R, Joannes-Boyau O, De Waele E, De Regt J, et al. Facing acid-base disorders in the third millennium - the Stewart approach revisited. Int J Nephrol Renovasc Dis. 2014;7:209-17. https://dx.doi.org/10.2147/IJNRD.S62126.

Walley KR. Use of central venous oxygen saturation to guide therapy. Am J Respir Crit Care Med. 2011;184(5):514-20. https://dx.doi.org/10.1164/rccm.201010-1584CI.

Hamm LL, Nakhoul N, Hering-Smith KS. Acid-Base Homeostasis. Clin J Am Soc Nephrol. 2015;10(12):2232-42. https://dx.doi.org/10.2215/CJN.07400715.

Ospina-Tascón GA, Hernández G, Cecconi M. Understanding the venous-arterial CO2 to arterial-venous O2 content difference ratio. Intensive Care Med. 2016;42(11):1801-4. https://dx.doi.org/10.1007/s00134-016-4233-7.

Zakharov S, Navrátil T, Pelclova D. Analysis of serum anion gap and osmolal gap in diagnosis and prognosis of acute methanol poisoning: clinical study in 86 patients. Monatsh Chem. 2015;146(5):787-94. https://dx.doi.org/10.1007/s00706-014-1374-7.

Kotrashetti V, Sonawane V, Bainade K, Lal Nath A. Renal Tubular Acidosis-An Unusual Presentation. IOSR J Dent Med Sci. 2015;14(12):65-6. https://dx.doi.org/10.9790/0853-141216566.

Choy KW, Wijeratne N, Lu ZX, Doery JC. Harmonisation of Osmolal Gap - Can We Use a Common Formula? Clin Biochem Rev. 2016;37(3):113-9.

Sánchez-Sámchez SM, Cachafeiro-Fuciños L, Flores-Cabeza E, García de lo Lorenzo-Mateos A. Alteraciones del metabolismo ácido base: alcalosis. Med - Programa Form Médica Contin Acreditado. 2015;11(79):4759-67. https://dx.doi.org/10.1016/j.med.2015.05.013.

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