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- W2018200727 abstract "Disturbances of acid–base homeostasis are a well recognised and clinically significant element of acute illness and physiological derangements. Over many decades, there have been high profile changes in perspectives of the interpretation, clinical effects, diagnostic significance and management of such metabolic alterations. One of the side-effects of these challenges has been to place a shroud of confusion over many aspects of understanding in acid–base physiology, and this decade is no different from others in adding further to this state. 1–4 More importantly perhaps, is that the more the academic arguments reign over the minutia of this topic, the less accessible it becomes to clinicians and the more distant it moves from practical clinical medicine. One of the major challenges for many aspects of medicine and critical care is to translate the complexities of topics for which we hold contentious and elaborate explanations into knowledge that can be utilised in day-to-day clinical management. In this respect, it is important, periodically, to re-unify modern scientific perspectives with their clinical and practical implications; indeed one area where this is particularly pertinent is the implications of acid–base disturbances on clinical care. Understanding of acid–base physiology has not been helped by the debate as to which ‘model’ is most clinically robust when interpreting blood results, although literature exists which highlights that these models are, in fact, little different. 1–4 Another area of long-standing debate is the therapeutic use of sodium bicarbonate in the management of patients with metabolic acidosis. 5–9 While this author is not an advocate of such an approach due to its often indiscriminate use as a means of ‘making the numbers look normal’, it is important to remain receptive to perspectives that advocate its use in a calculated and informed manner. Such a perspective is detailed by Mark Palazzo in this issue. In this practical review of bicarbonate therapy in clinical practice, he provides an elegant and pragmatic approach to the role of acid–base interpretation and management in critical illness. In so doing, he highlights the intimate role of acid–base disturbances in the development and management of shock, and illustrates both the useful diagnostic and therapeutic issues surrounding the metabolic disturbances that develop in such clinical states. Importantly, the focus is on the ‘real-life’ issues and provides an approach that is informed, yet dispassionate towards the academic controversies surrounding which fluid, cardiac output monitor or model of acid–base physiology should be adopted during the clinical management of critically ill patients. In so doing an elegant perspective of the management of patients in shock is revealed, that re-unifies the scientific and clinical significance of acid–base disturbances. Such commentary and review sets an example that warrants emulation in other areas of clinical medicine in which scientific debate and controversy exists. The latter require constant assessment and translation into clinical parlance so that those directly caring for patients are able to apply contemporary scientific thinking in a practical manner. Those taking a purely academic perspective of these matters risk being accused of existing in an ‘ivory tower’ (personal communication) unless they are able to bring this understanding into the workplace in a practicable manner. With regards the controversy of sodium bicarbonate therapy in patients with metabolic disturbances; perhaps the most important determinant for its use is whether or not the responsible clinician holds the comprehensive knowledge required to make a balanced and informed decision." @default.
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- W2018200727 date "2009-10-01" @default.
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- W2018200727 title "Acid–base disturbances: A need to reunify clinical and scientific medicine" @default.
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- W2018200727 doi "https://doi.org/10.1016/j.cacc.2009.07.011" @default.
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