Bench-to-bedside review: a brief history of clinical acid-base.
The history of assessing the acid-base equilibrium and associated disorders is intertwined with the evolution of the definition of an acid. In the 1950s clinical chemists combined the Henderson-Hasselbalch equation and the Bronsted-Lowry definition of an acid to produce the current bicarbonate ion-centred approach to metabolic acid-base disorders. Stewart repackaged pre-1950 ideas of acid-base in the late 1970s, including the Van Slyke definition of an acid. Stewart also used laws of physical chemistry to produce a new acid-base approach. This approach, using the strong ion difference (particularly the sodium chloride difference) and the concentration of weak acids (particularly albumin), pushes bicarbonate into a minor role as an acid-base indicator rather than as an important mechanism. The Stewart approach may offer new insights into acid-base disorders and therapies.
The University of Melbourne, Austin Health, Melbourne, Victoria, Australia. David.Story@austin.org.au
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D000136:Acid-Base Equilibrium; D000137:Acid-Base Imbalance / Q000175:diagnosis* / Q000266:history / Q000378:metabolism; D000143:Acids / Q000097:blood / Q000378:metabolism; D001639:Bicarbonates / Q000097:blood / Q000378:metabolism; D001784:Blood Gas Analysis; D049673:History, 20th Century; D006801:Humans; D007474:Ion Exchange; D019095:Point-of-Care Systems
D000143:Acids; D001639:Bicarbonates