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J Nephrol. 2013 Mar-Apr;26(2):254-65. doi: 10.5301/jn.5000191. Epub 2012 Sep 13.

Acid-base pathophysiology after 130 years: confusing, irrational and controversial.

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Department of Internal Medicine and Nephrology, St. Elisabeth Hospital, Curacao, Netherlands Antilles.



The interface between acid-base physiology and blood gas interpretation is historically both stimulating and turbulent. Since the pioneering work of many celebrated names in the history of acid-base disorders, such as Arrhenius, Henderson, Hasselbalch and many more to follow, substantial progress in acid-base knowledge has been made over the last 130 years. Out of the chaos of competing definitions, concepts and terms, many have tried to bring an orderly approach to acid-base balance. Nevertheless, the mechanisms responsible for acid-base balance are unfortunately still incompletely understood, and moreover, considerable controversy has developed over the past decade as to how to classify and understand acid-base derangements occurring as a result of abnormalities in acid-base balance.


Analysis of the medical literature, including a MEDLINE and EMBASE search, and a search of internal medicine, critical care and nephrology textbooks and reference lists, was performed on topics pertaining to the assessment and management of acid-base disorders, focusing on the gaps in our knowledge and on controversial issues.


Several confusing, irrational and controversial issues concerning acid-base nomenclature, reference values, pathophysiology, assessment of acid-base disorders and therapy were found.


Despite huge progress in acid-base knowledge, several confusing, irrational and controversial issues remain. Suggestions to reduce the confusion are provided.

[Indexed for MEDLINE]

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