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- W2036438129 abstract "To the Editor: Adrogue et al.1 give an overview of the three distinct approaches that are currently used in assessing acid–base disorders. In contrast to their assumption that the chloride level is normal in high anion gap acidosis (Table 2), there is often a low plasma chloride level because the plasma chloride decreases relative to sodium in these cases.2 They also assume that there is no significant effect of the plasma albumin on acid–base status in the physiological approach. This is not the case, as we have to adjust the anion gap for the plasma albumin.1 Indeed, after this adjustment there is no effect of albumin on the metabolic acid–base component. In the clinical case example 2, the authors give the impression that the physiological approach acknowledges a metabolic alkalosis and the physicochemical approach only diagnoses a hypoalbuminemic alkalosis. This is probably not true. A decrease in plasma albumin level by 1 g/dl usually results in an increase in bicarbonate level by 2.8 mmol/l.3 Accordingly, with a serum albumin level of 1.5 mmol/l, the expected serum bicarbonate level in this case will be 24+3 × 2.8 (8.4)=32.4 mmol/l. The patient's serum bicarbonate is higher (35 mmol/l), probably because of an additional metabolic alkalosis caused by the low potassium level of 3.2 mmol/l. In this context, the two approaches are therefore less different than the authors suggest. The fact that the secondary ΔPaCO2 is not defined in metabolic acidosis and alkalosis according to the physicochemical approach1 is probably the most important limitation of this method, as additional respiratory disturbances may be missed." @default.
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- W2036438129 date "2010-04-01" @default.
- W2036438129 modified "2023-09-28" @default.
- W2036438129 title "Assessment of acid–base disorders" @default.
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- W2036438129 doi "https://doi.org/10.1038/ki.2009.553" @default.
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