[Practical diagnostics of acid-base disorders. Part II: Complex metabolic disturbances]

Abstract

The second part of this overview focuses on how to assess more complex metabolic causes of acid-base imbalance. This is precisely the battlefield where most of the fiery debates between the Copenhagen, the Boston and the Stewart schools aroused. While the first part of the overview merged the practical strengths of the three different approaches, in part II it will be shown how the Stewart approach in particular helps in understanding complex metabolic acid base disorders with emphasis on the often underrated role of chloride ions or the weak acid albumin. With the Stewart diagnostic approach in mind the practitioner might wish considering therapeutic options that differ from what is suggested by the more traditional approaches. The specific diagnostic steps are integrated into a simplified algorithm and an acid-base calculator is provided.