Biochemical Approach of Acid-Base Disturbances
xml (Español)


metabolic acidosis
respiratory acidosis
metabolic alkalosis
respiratory alkalosis
Acid-base equilibrium
critical care
blood gas analysis
cellular respiration

How to Cite

Nitsch Prado A. Biochemical Approach of Acid-Base Disturbances. Rev. Colomb. Nefrol. [Internet]. 2023 Jul. 25 [cited 2024 Apr. 20];10(3). Available from:


Background: The current paradigms in arterial blood gas analysis are based on mathematical or physicochemical models that require complex algorithms for interpretation. This leads to avoidance or dislike from health care professionals.

Purpose: To formulate a new approach to the analysis and classification of acid base disturbances.

Methodology: we conducted a systematic review of the related literature and a paradigm shift for data interpretation.

Results: Acid-base disorders can be grouped and managed according to the underlying biochemical processes.

Conclusions: This proposal represents a new classification, which groups acid base disorders according to the underlying causal biochemical process. Disorders with an elevated anion gap relate to alterations in cellular respiration (energy/ATP production)- All disturbances with  normal anion gap relate to transmembrane ion exchange.
xml (Español)


Berend K. Diagnostic Use of Base Excess in Acid-Base Disorders. NEJM. 2018 ;378(15):1419-1428.

Dzierba AL, Abraham P. A Practical Approach to Understanding Acid-Base Abnormalities in Critical illness. J Pharm Practice. 2011;24(1):17-26.

Ahmad M, Wolberg A, Kahwaji C. Biochemistry, Electron Transport Chain.. [Online]. StatPearls; 2021 [cited 2022]. Available from:

Anesthesia Education Website. Acid-base physiology. [Online]. [cited 2022] Available from:

United states environmental Protection Agency. Technical Overview of Volatile Organic Compounds. [Online].; 2021. Available from:

Kaufman DA. Interpretation of ABgs. [Online]. American Thoracic Asociation. [cited 2022] Available from:

Saha A, Bhattacharya M, Sharma G, Lee SS, Chakraborty C. Probable Molecular Mechanism of Remdesivir for the Treatment of COVID-19: Need to Know More. J. ARCMED. 2020;51(6):585-586.

Blough B, Moreland A, Mora A. Metformin-induced lactic acidosis with emphasis on the anion gap. Proc (Bayl Univ Md Cent). 2015;28(1):31-33.

Palmer BF, Clegg DJ. Salicylate Toxicity. NEJM. 2020;382:2544-2555.

DuBose TD. Metabolic and respiratory acidosis. In Wilcox CS. Therapy in Nephrology and Hypertension.: Saunders Elsevier. 2008:368-380.

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.




Download data is not yet available.