EMCrit Podcast 44 – Acid Base: Part I

I have spoken about it for a while, but I’ve finally gotten it done: the acid-base podcast. The podcast is going to be in 3 or 4 parts. They are segmented from a lecture I gave to my residents recently. Part II discusses the mathematics of acid base and Part III goes through actual problems. Part IV then discusses the acid-base of administered solution.

This lecture discusses a quantitative approach to acid base management. This is also known  as the Fencl-Stewart approach, the strong-ion approach or the physicochemical approach. It provides explanations for why acid base disorders occur in human pathophysiology. The classic method used in the USA is the Henderson-Hasselbalch (misspelled on my slides) approach. I find this method to provide no comprehensive explanation for why things are as they are. Through the quantitative approach, you can also understand the H&H approach and continue to use it with new insight.

This first part deals with the preliminaries. Part II will go into clinical applications.

After listening to the podcast, I recommend reading these articles:

For the next part of the series, you will need a print out of this sheet:
EMCrit Acid-Base Sheet

Want to read more?

Need an Audio Only Version?
Acid Base Part I MP3 [Play] (Right Click and Choose Save as)

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Comments

  1. Matt Messa says

    Hey Scott,

    From what I can tell, the first day your new Podcast comes out, it is not yet on the i-Tunes list. So the only way to listen to it is as a quicktime file on my PC. Is there another way? I usually just have to wait painfully to see that i-tunes has your latest but this is sometimes a day or two. Thanks for your hard work!

    Matt

  2. Zach Webb says

    Great first part of the acid-base lecture. In fact, great website overall.

    I start 3rd year of med school in July, and these lectures will no doubt improve my understanding of medicine and what goes on in the hospital.

    Thanks!

      • Zach Webb says

        Here they teach us H-H pretty religiously. What’s CO2 doing? What’s bicarb doing? What’s the pH? A little bit on anion gap. It all stays pretty superficial, and every discussion leaves you wanting more.

        So, it’s nice to get a fresh perspective on the topic. Thanks again.

  3. Chris Fedoruk says

    Hey Scott:

    I light of this paper, do you guys still use NS at Hurst, or are you prefering LR. Just curious.

  4. Christopher Hapner says

    This lecture is very helpful for my understanding of Acid/base coming from a 1st year. I really enjoy coming to the website to clarify and solidify many of the concepts we are covering in class.

  5. Austin Johnson says

    Hey Scott, a quick question (but afraid its a long answer)
    When the SID is decreased by giving NS, where does the H+ come from? Why does the decreased SID really cause an acidosis? It can’t be from the H2CO3 dissociating to H+ as that would also increase your HCO3-, right? I have been reading everything on Stewart’s approach that we have access to (Kaplan, Morgan, etc) but no one really explains it (and we can’t get a copy of the Stewart paper).
    Thanks
    Austin

  6. Dr. O. Ballo says

    My name is Olivier, MD at the university hospital of frankfurt.

    So when you give diuretics (Furosemid, Torasemid) you will get low serum sodium leading to a small SID and thus acidosis but on the other hand there will be more sodium in the Collecting duct system in the kidney that will be taken into the principal cells causing a Transepithelial potential difference that will lead to H+ excretion by the H+-ATPase.

    So will diuretics rather cause azidosis or alcalosis?

Trackbacks

  1. […] A while back I asked the twitterverse whether anyone could recommend a good app for arterial blood gas (ABG) interpretation. The deafening silence showed me that (a) I have very few followers and (b) if I want an ABG app review, I have to write it myself. Hence this blog post. A few preliminary remarks are in order. If you don’t already know how to interpret tricky blood gases, go listen to the four-part podcast series by Scott Weingart  part one can be found here […]

  2. […] Using the physicochemical/ Stewart approach, the Strong Ion Difference (normal is 38) is markedly low (Na – Cl = 146 – 129 = 17). The causes of this are the same as the causes of NAGMA (see also EMCrit — Acid Base in the Critically Ill – Part I). […]

  3. […] A while back I asked the twitterverse whether anyone could recommend a good app for arterial blood gas (ABG) interpretation. The deafening silence showed me that (a) I have very few followers and (b) if I want an ABG app review, I have to write it myself. Hence this blog post. A few preliminary remarks are in order. If you don’t already know how to interpret tricky blood gases, go listen to the four-part podcast series by Scott Weingart  part one can be found here […]

  4. […] del tycker att detta är ett betydligt enklare sätt att tänka. Se, lyssna och lär från emcrit del I, II, III och IV Share this:TwitterFacebookGillaGillaBe the first to like this. This entry was […]

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