Acid–Base Analysis in the Operating Room: A Bedside Stewart Approach

Story, David A.

doi:10.1097/aln.0000000000004712

Anesthesiology

2023

DOI: 10.1097/aln.0000000000004712

|View full text |Cite

Acid–Base Analysis in the Operating Room: A Bedside Stewart Approach

David A. Story

Abstract: The bedside Stewart approach to acid–base disorders is a simple, pragmatic tool that can assist anesthesiologists in analyzing and managing acid–base changes in the operating room, particularly metabolic acidosis.

Help me understand this report

Search citation statements

Order By: Relevance

Paper Sections

Select...

Citation Types

Supporting

Mentioning

Contrasting

Year Published

2023

2024

Publication Types

Select...

Article3

Relationship

Self Cite1

Independent2

Authors

Journals

Cited by 3 publications

References 43 publications

(154 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

Respiratory Changes and Acid–Base Compensation: Watch the Salt

Story

2023

Anesthesiology

Self Cite

View full text Add to dashboard Cite

Respiratory Changes and Acid–Base Compensation: Watch the Salt

Story

2023

Anesthesiology

Self Cite

View full text Add to dashboard Cite

Dueling Diagnostics for Acid–Base Derangements: Bicarbonate-centered ApproachversusBase Excess and Stewart Approaches

Ende,

Rathmell,

Wanderer

2023

Anesthesiology

View full text Add to dashboard Cite

Quantifying pH-induced changes in plasma strong ion difference during experimental acidosis: clinical implications for base excess interpretation

Giosa,

Zadek,

Busana

et al. 2024

Journal of Applied Physiology

View full text Add to dashboard Cite

It is commonly assumed that changes in plasma strong ion difference (SID) result in equal changes in whole-blood base excess (BE). However, at varying pH, albumin ionic-binding and transerythrocyte shifts alter the SID of plasma without affecting that of whole-blood (SIDwb), i.e., the BE. We hypothesize that, during acidosis, 1) an expected plasma SID (SIDexp) reflecting electrolytes redistribution can be predicted from albumin and hemoglobin's charges, and 2) only deviations in SID from SIDexp reflect changes in SIDwb, and therefore, BE. We equilibrated whole-blood of 18 healthy subjects (albumin=4.8±0.2 g/dL, hemoglobin=14.2±0.9 g/dL), 18 hypoalbuminemic and anemic septic patients (albumin=3.1±0.5 g/dL, hemoglobin=10.4±0.8 g/dL), and 10 healthy subjects after in-vitro induced isolated anemia (albumin=5.0±0.2 g/dL, hemoglobin=7.0±0.9 g/dL) with varying CO2 concentrations (2-20%). Plasma SID increased by 12.7±2.1, 9.3±1.7, and 7.8±1.6 mEq/L, respectively (p<0.01) and its agreement (bias[limits of agreement]) with SIDexp was strong: 0.5[-1.9;2.8], 0.9[-0.9;2.6], and 0.3[-1.4;2.1] mEq/L, respectively. Separately, we added 7.5 or 15 mEq/L of lactic or hydrochloric acid to whole-blood of 10 healthy subjects obtaining BE of -6.6±1.7, -13.4±2.2, -6.8±1.8, and -13.6±2.1 mEq/L, respectively. The agreement between ∆BE and ∆SID was weak (2.6[-1.1;6.3] mEq/L), worsening with varying CO2 (2-20%): 6.3[-2.7;15.2] mEq/L. Conversely, ∆SIDwb (the deviation of SID from SIDexp) agreed strongly with ∆BE at both constant and varying CO2: -0.1[-2.0;1.7], and -0.5[-2.4;1.5] mEq/L, respectively. We conclude that BE reflects only changes in plasma SID that are not expected from electrolytes redistribution, the latter being predictable from albumin and hemoglobin's charges.

show abstract

scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.

Contact Info

customersupport@researchsolutions.com

10624 S. Eastern Ave., Ste. A-614

Henderson, NV 89052, USA

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Blog Terms and Conditions API Terms Privacy Policy Contact Cookie Preferences Do Not Sell or Share My Personal Information

Made with 💙 for researchers

Part of the Research Solutions Family.

Acid–Base Analysis in the Operating Room: A Bedside Stewart Approach

Abstract: The bedside Stewart approach to acid–base disorders is a simple, pragmatic tool that can assist anesthesiologists in analyzing and managing acid–base changes in the operating room, particularly metabolic acidosis.

Cited by 3 publications

References 43 publications

Respiratory Changes and Acid–Base Compensation: Watch the Salt

Respiratory Changes and Acid–Base Compensation: Watch the Salt

Dueling Diagnostics for Acid–Base Derangements: Bicarbonate-centered ApproachversusBase Excess and Stewart Approaches

Quantifying pH-induced changes in plasma strong ion difference during experimental acidosis: clinical implications for base excess interpretation

Contact Info

Product

Resources

About