The standard strong ion difference, standard total titratable base, and their relationship to the Boston compensation rules and the Van Slyke equation for extracellular fluid

Abstract

A general formalism for calculating physiological acid-base balance in multiple compartments is extended to the combined interstitial, plasma, and erythrocyte multicompartment system in humans using the Siggaard-Andersen approximation for interstitial fluid. The resulting equations for total titratable base and strong ion difference reproduce the experimental in vivo carbon dioxide titration curve as well as the experimental strong ion difference value of the interstitial, plasma, and erythrocyte system in normal man. The "Boston rules" for compensation in acute respiratory acidosis and alkalosis are then derived analytically from the model. The Van Slyke equation for the interstitial, plasma, and erythrocyte system is also derived and shown to approximate the Van Slyke equation for standard base excess.