Intensive Care Medicine

, Volume 42, Issue 3, pp 436–439 | Cite as

Understanding the role of the cerebrospinal fluid in acid–base disorders

  • Thomas LangerEmail author
  • Alberto Zanella
  • Pietro Caironi
Understanding the Disease


The importance of acid–base interpretation is witnessed by the bulk of literature constantly being published on the topic [1, 2]. However, none of the recently published papers specifically addresses the acid–base equilibrium of the cerebrospinal fluid (CSF), which is an important compartment, since it influences the activity of the central controllers of respiration.

Here, we will briefly discuss the characteristics of CSF acid–base equilibrium and their implications on the control of breathing, basing our reasoning on Stewart’s approach [3]. Moreover, we will highlight some clinical implications that, we believe, are usually not fully considered by clinicians.

Characteristics of CSF and blood–CSF barrier

According to Stewart’s approach, pH in biologic fluids is independently regulated by three variables: (1) partial pressure of carbon dioxide (PCO2), (2) strong ion difference (SID), the difference between the sum of strong cations and anions, and (3) the concentration...


Fixed Acid Base Disorder Plasma Chloride Cerebral Fluid Hypocapnic Alkalosis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We are very grateful to Dr. Simone Sosio for graphical assistance.

Compliance with ethical standards

Conflicts of interest

The authors declare no conflict of interest regarding this commentary.


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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2015

Authors and Affiliations

  • Thomas Langer
    • 1
    Email author
  • Alberto Zanella
    • 2
  • Pietro Caironi
    • 1
    • 3
  1. 1.Dipartimento di AnestesiaRianimazione ed Emergenza Urgenza, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore PoliclinicoMilanItaly
  2. 2.Dipartimento di Scienze della SaluteUniversità degli Studi Milano, BicoccaMonzaItaly
  3. 3.Dipartimento di Fisiopatologia Medico, Chirurgica e dei TrapiantiUniversità degli Studi di MilanoMilanItaly

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