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

Background: 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. Material & Method: 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.

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Tubular disorders

Paediatric Nephrology ◽

10.1093/med/9780198784272.003.0007 ◽

2019 ◽

pp. 161-200

Author(s):

Lesley Rees ◽

Nicholas J.A Webb ◽

Detlef Bockenhauer ◽

Marilynn G. Punaro

Keyword(s):

Collecting Duct ◽

Sodium Reabsorption ◽

Correct Identification ◽

Acid Base Balance ◽

Acid Base ◽

Plasma Electrolyte ◽

Tubular Disorders ◽

Appropriate Treatment ◽

Base Balance ◽

Underlying Disorder

Tubular function is critical for the maintenance of electrolyte and acid–base balance. Consequently, acid–base disorders typically manifest with alterations in plasma electrolyte concentrations and/or pH. Tubular handling of the various electrolytes is often linked on a molecular level. For example, secretion of potassium and protons in the collecting duct is dependent on sodium reabsorption. Consequently, tubular disorders typically present with characteristic patterns of electrolyte and acid–base abnormalities, which can serve as biochemical ‘fingerprints’ for the accurate diagnosis of the underlying disorder. Recognition of these ‘fingerprints’ is critical as correct identification of the underlying disorder is key for appropriate treatment.

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A Clinical Approach to Teaching Acid-base Balance: An Innovation in Dietetic Education

Journal of the American Dietetic Association ◽

10.1016/s0002-8223(95)00589-7 ◽

1995 ◽

Vol 95 (9) ◽

pp. A68

Author(s):

V.K. Kuzniar ◽

J. Karkeck ◽

C. Cheney

Keyword(s):

Clinical Approach ◽

Acid Base Balance ◽

Acid Base ◽

Dietetic Education ◽

Base Balance ◽

Approach To Teaching

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Clinical Approach to Acid-Base Balance

Anaesthesia, Pain, Intensive Care and Emergency Medicine — A.P.I.C.E. ◽

10.1007/978-88-470-2099-3_52 ◽

2002 ◽

pp. 617-630

Author(s):

S. Magder

Keyword(s):

Clinical Approach ◽

Acid Base Balance ◽

Acid Base ◽

Base Balance

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Higher Dietary Acidity is Associated with Lower Bone Mineral Density in Postmenopausal Iranian Women, Independent of Dietary Calcium Intake

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831/a000207 ◽

2014 ◽

Vol 84 (3-4) ◽

pp. 0206-0217 ◽

Cited By ~ 8

Author(s):

Seyedeh-Elaheh Shariati-Bafghi ◽

Elaheh Nosrat-Mirshekarlou ◽

Mohsen Karamati ◽

Bahram Rashidkhani

Keyword(s):

Calcium Intake ◽

Dietary Calcium ◽

Dietary Calcium Intake ◽

Dietary Intakes ◽

Iranian Women ◽

Acid Base Balance ◽

Mineral Density ◽

Acid Base ◽

Base Balance ◽

Dietary Acid

Findings of studies on the link between dietary acid-base balance and bone mass are relatively mixed. We examined the association between dietary acid-base balance and bone mineral density (BMD) in a sample of Iranian women, hypothesizing that a higher dietary acidity would be inversely associated with BMD, even when dietary calcium intake is adequate. In this cross-sectional study, lumbar spine and femoral neck BMDs of 151 postmenopausal women aged 50 - 85 years were measured using dual-energy x-ray absorptiometry. Dietary intakes were assessed using a validated food frequency questionnaire. Renal net acid excretion (RNAE), an estimate of acid-base balance, was then calculated indirectly from the diet using the formulae of Remer (based on dietary intakes of protein, phosphorus, potassium, and magnesium; RNAERemer) and Frassetto (based on dietary intakes of protein and potassium; RNAEFrassetto), and was energy adjusted by the residual method. After adjusting for potential confounders, multivariable adjusted means of the lumbar spine BMD of women in the highest tertiles of RNAERemer and RNAEFrassetto were significantly lower than those in the lowest tertiles (for RNAERemer: mean difference -0.084 g/cm2; P=0.007 and for RNAEFrassetto: mean difference - 0.088 g/cm2; P=0.004). Similar results were observed in a subgroup analysis of subjects with dietary calcium intake of >800 mg/day. In conclusion, a higher RNAE (i. e. more dietary acidity), which is associated with greater intake of acid-generating foods and lower intake of alkali-generating foods, may be involved in deteriorating the bone health of postmenopausal Iranian women, even in the context of adequate dietary calcium intake.

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