ABSTRACTS from 16th International COnference on ... - CRRT Online

C19
Acid Base and Electrolyte Problems in the Critically Ill 1
John A. Kellum MD
10:00-11:30
Wednesday, February 15
Educational Objectives:
To understand the relationship between the various methods of evaluating acid-base physiology
To appreciate the difference between independent and dependent variables in determining acid-base balance
To become familiar with terms and concepts of physical chemistry as they relate to clinical acid-base analysis
Content Description:
Acid-base disorders are common in the critically ill and injured. There is no evidence that one method of acidbase
analysis is superior to another and as such, personal preference and training largely dictate what method is
used. Most intensivists use base excess along with bicarbonate-based analysis and more commonly in recent
years, they have integrated physical chemical approaches into their clinical practice. This approach is in marked
distinction to what is advocated by much of the nephrology community where discussions center around what is
the “correct approach”. However, this controversy misses the point. The various approaches to acid-base analysis
are not mutually excusive and the savvy clinician uses all the tools at his or her disposal, particularly when the
situation is critical. Indeed the modern approach to acid-base analysis combines various methodologies.
Suggested Reading:
1. Kellum JA. Determinants of Blood pH in Health and Disease. Critical Care 2000;4:6-14
2. Corey HE. Stewart and beyond: new models of acid-base balance. Kidney Int 2003;64:777-787
3. Adrogue' HJ, Gennari FJ, Galla JH, Madias NE. Assessing acid-base disorders. Kidney Int 2009;76:1239-
1247
4. Kellum JA. Disorders of acid-base balance. Crit Care Med 2007;35:2630-2636
5. Kaplan LJ, Kellum JA. Comparison of acid-base models for prediction of hospital mortality after trauma.
Shock 2008;29:662-666
98