title: Old and new approaches to the interpretation of acid-base metabolism, starting from historical data applied to diabetic acidosis.
abstract: The approach to acid-base chemistry in medicine includes several methods. Currently, the two most popular procedures are derived from Stewart's studies and from the bicarbonate/BE-based classical formulation. Another method, unfortunately little known, follows the Kildeberg theory applied to acid-base titration. By using the data produced by Dana Atchley in 1933, regarding electrolytes and blood gas analysis applied to diabetes, we compared the three aforementioned methods, in order to highlight their strengths and their weaknesses. The results obtained, by reprocessing the data of Atchley, have shown that Kildeberg's approach, unlike the other two methods, is consistent, rational and complete for describing the organ-physiological behavior of the hydrogen ion turnover in human organism. In contrast, the data obtained using the Stewart approach and the bicarbonate-based classical formulation are misleading and fail to specify which organs or systems are involved in causing or maintaining the diabetic acidosis. Stewart's approach, despite being considered 'quantitative', does not propose in any way the concept of 'an amount of acid' and becomes even more confusing, because it is not clear how to distinguish between 'strong' and 'weak' ions. As for Stewart's approach, the classical method makes no distinction between hydrogen ions managed by the intermediate metabolism and hydroxyl ions handled by the kidney, but, at least, it is based on the concept of titration (base-excess) and indirectly defines the concept of 'an amount of acid'. In conclusion, only Kildeberg's approach offers a complete understanding of the causes and remedies against any type of acid-base disturbance.
authors.affiliation: a Division of Nephrology , Civil and University Hospital , Santa Maria Della Misericordia , Udine , Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Mioni
authors.affiliation: a Division of Nephrology , Civil and University Hospital , Santa Maria Della Misericordia , Udine , Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Marega
authors.affiliation: a Division of Nephrology , Civil and University Hospital , Santa Maria Della Misericordia , Udine , Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Lo Cicero
authors.affiliation: a Division of Nephrology , Civil and University Hospital , Santa Maria Della Misericordia , Udine , Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Montanaro
mesh_terms: D000136:Acid-Base Equilibrium; D001639:Bicarbonates / Q000097:blood / Q000652:urine; D001784:Blood Gas Analysis; D002255:Carbonic Acid / Q000097:blood / Q000652:urine; D016883:Diabetic Ketoacidosis / Q000097:blood* / Q000266:history / Q000503:physiopathology / Q000652:urine*; D004573:Electrolytes / Q000097:blood / Q000652:urine; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D006863:Hydrogen-Ion Concentration; D006878:Hydroxides / Q000097:blood / Q000652:urine; D007668:Kidney / Q000378:metabolism* / Q000503:physiopathology; D011522:Protons
chemical_list: D001639:Bicarbonates; D004573:Electrolytes; D006878:Hydroxides; D011522:Protons; D002255:Carbonic Acid; C031356:hydroxide ion
keywords: Amount of acid; base excess; carbonic acid; diabetic acidosis; metabolizable acid; metabolizable anions; net acid excretion; non-metabolizable base; strong ion difference; titratable acid