title: Acid-base pathophysiology after 130 years: confusing, irrational and controversial.
abstract: BACKGROUND
  The interface between acid-base physiology and blood gas interpretation is historically both stimulating and turbulent. Since the pioneering work of many celebrated names in the history of acid-base disorders, such as Arrhenius, Henderson, Hasselbalch and many more to follow, substantial progress in acid-base knowledge has been made over the last 130 years. Out of the chaos of competing definitions, concepts and terms, many have tried to bring an orderly approach to acid-base balance. Nevertheless, the mechanisms responsible for acid-base balance are unfortunately still incompletely understood, and moreover, considerable controversy has developed over the past decade as to how to classify and understand acid-base derangements occurring as a result of abnormalities in acid-base balance.
  
  
  METHODS
  Analysis of the medical literature, including a MEDLINE and EMBASE search, and a search of internal medicine, critical care and nephrology textbooks and reference lists, was performed on topics pertaining to the assessment and management of acid-base disorders, focusing on the gaps in our knowledge and on controversial issues.
  
  
  RESULTS
  Several confusing, irrational and controversial issues concerning acid-base nomenclature, reference values, pathophysiology, assessment of acid-base disorders and therapy were found.
  
  
  CONCLUSIONS
  Despite huge progress in acid-base knowledge, several confusing, irrational and controversial issues remain. Suggestions to reduce the confusion are provided.
authors.affiliation: Department of Internal Medicine and Nephrology, St. Elisabeth Hospital, Curacao, Netherlands Antilles. kberend@sehos.an
authors.forename: Kenrick
authors.initials: K
authors.lastname: Berend
mesh_terms: D000136:Acid-Base Equilibrium; D000137:Acid-Base Imbalance / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy; D000138:Acidosis / Q000097:blood / Q000503:physiopathology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D001639:Bicarbonates / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001784:Blood Gas Analysis / Q000592:standards; D002712:Chlorides / Q000097:blood; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D006863:Hydrogen-Ion Concentration; D019344:Lactic Acid / Q000097:blood; D008297:Male; D008875:Middle Aged; D012015:Reference Standards; D012709:Serum Albumin / Q000378:metabolism; D017693:Sodium Bicarbonate / Q000627:therapeutic use; D009626:Terminology as Topic; D055815:Young Adult
chemical_list: D001639:Bicarbonates; D015415:Biomarkers; D002712:Chlorides; D012709:Serum Albumin; D019344:Lactic Acid; D017693:Sodium Bicarbonate