Acid–base equilibrium: The best clinical approach

Abstract

a b s t r a c tAcid-base balance disorders can be found in a primary or secondary form in patients with a disease process such as Diabetes Mellitus or acute renal failure, among others. The objective of this article is to explain and guide the correlationship between the clinical findings in the patient and the parameters of arterial blood gases in a simple and precise manner, in order to make the correct acid-base balance diagnosis and adequate therapeutic interventions.A non-systematic review of the scientific literature was conducted through a search in the PubMed, Science Direct, Scopus, and OvidSP databases. The conclusion was that base excess or deficit in arterial blood gases is a useful tool which along with the clinical history, pH, and partial pressure of CO 2 , provides an accurate estimate of the metabolic component of the acid-base balance. Palabras clave:Acidosis Alcalosis Colombia Desequilibrio Ácido-Base Anestesia r e s u m e n Las alteraciones del Equilibrio Ácido-Base se pueden presentar en pacientes de forma primaria o secundaria a un proceso patológico como la Diabetes Mellitus o la falla renal entre otros. El objetivo es explicar y orientar la correlación clínica del paciente con los parámetros de los gases arteriales de manera sencilla y precisa, para realizar un diagnóstico de las alteraciones del Equilibrio Ácido-Base correcto, que permita efectuar intervenciones terapéuticas adecuadas y oportunas. Se realizó una revisión no sistemática de la literatura científica en la cual se consultaron las siguientes bases de datos: PubMed, ScienceDirect, ଝ Please cite this article as: Aristizábal-Salazar RE, Calvo-Torres LF, Valencia-Arango LA, Montoya-Cañon M, Barbosa-Gantiva O, Hincapié-Baena V. Equilibrio Ácido-Base: el mejor enfoque clínico. Rev Colomb Anestesiol. 2015;43:219-224. r e v c o l o m b a n e s t e s i o l . 2 0 1 5;4 3(3):219-224Scopus y OvidSP en busca de artículos relevantes. Se concluyó que el exceso o déficit de base es una herramienta útil de los gases arteriales, que aunada a la historia clínica, el pH y la presión parcial de CO 2 estima de forma muy precisa el componente metabólico del Equilibrio Ácido-Base.

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

“…and depends on the complete oxidation of the anions during the Krebs cycle. 3,16,19,20 The renal system, eliminates the H + produced in the amino acids metabolism, through the formation of urea or ammonium ion, at the same time that the secretion of H in the proximal tubule increases or Le Chatelier principle establishes that when the concentration, pressure or temperature variables change, the systems in equilibrium react accordingly to reestablish a new equilibrium state, which indicates that if more H + are produced, the equation will shift to the left so that more reagents are formed and the system remains in equilibrium. 12,17 The conversion of CO 2 into H 2 CO 3 is slowly catalyzed by the carbonic anhydrase present in the pulmonary and renal tissues.…”

“…The distal acidification is constituted not only by the titratable acidity, but fundamentally by the ammoniacal acidity, which is regulable as it can be induced by aldosterone. 3,12,13,18,21 Therefore, the acid-base balance disorders will have a compensatory response: renal, mediated by HCO 3 -in respiratory disorders, and respiratory, mediated by CO 2 in metabolic disorders (Table 2).…”

“…1,2 The proper identification of the acid-base disorder allows to characterize the causative pathological process. [1][2][3][4] Classically, different authors: Siggard, Andersen, Henderson, Emmett, Hasselbalch and Stewart have contributed to the understanding of the acid-base balance. [3][4][5][6] In clinical practice, three models are currently used: (A) The Henderson-Hasselbalch equation to classify the acid-base disorders.…”

“…[1][2][3][4] Classically, different authors: Siggard, Andersen, Henderson, Emmett, Hasselbalch and Stewart have contributed to the understanding of the acid-base balance. [3][4][5][6] In clinical practice, three models are currently used: (A) The Henderson-Hasselbalch equation to classify the acid-base disorders. 6 (B) The base excess concept by Siggaard-Andersen 7 as a parameter to assess the magnitude of the metabolic abnormality.…”

“…4 The correct interpretation of the blood gasometry requires the integration of the above mentioned three models in order to specify a diagnosis, quantify a therapeutic response and monitor the severity or the progression of a pathological process. [3][4][5] The aim of this article is to originally propose a diagnostic algorithm for guiding physicians to perform an adequate correlation between the clinical condition of critical patients and their acidbase parameters, in order to achieve an accurate characterization of the patients´ acid-base disorders.…”