Physical Chemistry and Clinical Acid-Base Physiology

  • J. A. Kellum
Conference paper


Unlike most other areas of medicine, critical care does not confine itself to a specific organ or region of the body, or to a specific disease process. Rather, practitioners of critical care are concerned with the interaction of various organs and disease states. Indeed, our practice is often defined by the management of certain syndromes (e.g., sepsis, multi-organ failure) and pathophysiological conditions (e.g., shock) that do not fall neatly into the domain of a single subspecialty. Acid-base regulation is one of these “areas” of medicine that crosses organ-specific boundaries and the intensive care unit (ICU) is often the place where severe derangements in this area exist. For these reasons, intensivists, and others called upon to care for critically ill patients in the ICU, operating room, or emergency department are expected to diagnose and manage complicated disorders of acid-base balance. Accordingly, it is fundamental to the practice of critical care to have an advanced understanding of acid-base chemistry and physiology. Unfortunately, our “acid-base science” has not kept pace with advances in other areas germane to critical care (e.g., mechanisms of inflammation and oxygen delivery to the tissues) and as such, our clinical practice of diagnosis and management of acid-base disorders is far less advanced. Indeed, little has changed in this field in over 40 years.


Hydroxyethyl Starch Water Dissociation Strong Anion Plasma Lactate Concentration Unmeasured Anion 
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Copyright information

© Springer-Verlag Italia 2002

Authors and Affiliations

  • J. A. Kellum
    • 1
  1. 1.Department of Critical Care MedicineUniversity of Pittsburgh Medical CenterPittsburghUSA

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