According to Albert Einstein, “Everything should be made as simple as possible, but not simpler.” This is a similar sentiment to Occam's Razor. Acid-base analysis is a good example of this principle. It's possible to make things extraordinarily fancy and complex. To analyze pH status we could obtain an ABG, complete blood count, calcium, magnesium, phosphate, and albumin levels and feed them all into a supercomputer. However, there's no solid clinical evidence that fancy models are clinically superior to simple models.
From a theoretical standpoint, fancy models (e.g. Stewart's Physiochemical model) are undoubtedly superior. The physical chemist will look down upon traditional acid-base analysis as pedestrian (which is true, from a physical chemistry standpoint). However, for worker bee clinicians, we need something which can be applied in a uniform and reliable fashion without requiring a ton of labs. This chapter describes such an approach. It's a bit old-fashioned and simple but make no mistake – it cuts like a knife.
The IBCC chapters are generally released in quasi-random order. However, in order to try to consolidate an understanding of metabolic pH analysis, the next three sections will sequentially explore various aspects of metabolic pH abnormalities.
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The IBCC chapter is located here.
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You guys are THE BEST! We love listening to your podcast to study and just for the awesome discussion, thank you SO much for all your time and contribution to medicine. I just got my first job out of PA school in a critical care fellowship and I am so excited! This is a question that I have asked to residents I’ve worked with before, but never have gotten a good answer. If you have an anion gap on your BMP panel, does this mean you have a metabolic acidosis regardless of what a pH might be? The BMP doesn’t… Read more »