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Vol. 67. Issue 1.
Pages 20-34 (January 2020)
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Vol. 67. Issue 1.
Pages 20-34 (January 2020)
Review
The arterial blood gas algorithm: Proposal of a systematic approach to analysis of acid-base disorders
El algoritmo de la gasometría arterial: propuesta de un enfoque sistemático para el análisis de los trastornos del equilibrio ácido-base
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S. Rodríguez-Villara,
Corresponding author
sancho.villar@nhs.net

Corresponding author.
, B.M. Do Valeb, H.M. Fletchera
a Critical Care Department, King’s College Hospital, London, UK
b Critical Care Department, Centro Hospitalar Universitário do Porto (CHUP), Porto, Portugal
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Tables (6)
Table 1. Validation of the internal consistency of the acid-base data.
Table 2. Primary acid-base disorders and Secondary Compensatory Response.
Table 3. Conditions associated with metabolic acidosis.
Table 4. Conditions associated with high mineralocorticoid activity.
Table 5. Pathophysiologic consequences of severe alkalemia by organ system.
Table 6. Common mixed acid-base disorders in intensive care.
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Abstract

Abnormalities in the acid-base balance are common clinical problems that can have deleterious effects on cellular function, and can suggest various disorders. Therefore, it is important for the clinician to correctly diagnose the acid-base disorder (s) in order to provide the best treatment.

Three approaches have been proposed to evaluate acid-base disorders: a bicarbonate-centric approach; the Stewart approach; and the base excess approach. Although the latter two have many adherents, we will only discuss the bicarbonate-centric approach.

This approach is simpler to use at the bedside, involves a physiological evaluation of the acid-base disorder, presents an easily understandable approach to severity assessment, and provides a more solid foundation for the development of effective therapies. Therefore, the following discussion will be limited to an examination of this approach.

In this case-centric review, important new concepts will be introduced first; their benefits and limitations discussed; and then their use in the analysis of real cases will be shown.

A systematic approach algorithm that incorporates these new concepts has been generated and will be highlighted.

Keywords:
Arterial blood gas
Acid-base disorders
Algorithm of arterial gas analysis
Resumen

Las anomalías en el equilibrio ácido-base son problemas clínicos comunes y pueden tener efectos perjudiciales en la función celular y ser el indicio de varios trastornos. Por lo tanto, es importante para el clínico, el hacer un diagnóstico preciso de los trastornos ácido-base presentes para un tratamiento adecuado.

Se han propuesto tres enfoques para evaluar los trastornos ácido-base: un enfoque centrado en el bicarbonato; El enfoque de Stewart y el enfoque de exceso de base. Aunque los dos últimos tienen muchos adeptos, sólo discutiremos el enfoque centrado en el bicarbonato.

Este enfoque es más fácil de utilizar desde el punto de vista clínico, tiene una evaluación fisiológica del trastorno ácido-base, presenta una lógica fácilmente comprensible para evaluar la gravedad y proporciona además, una base más sólida para el desarrollo de terapias efectivas. Por lo tanto, nuestro trabajo se limitará a un examen en profundidad de esta teoría.

En esta revisión, primero se introducirán conceptos importantes nuevos; sus beneficios y discusión de sus limitaciones; y luego se mostrará su utilización para analizar casos reales.

Se ha generado un algoritmo para abordar de forma sistemática el análisis que incorpora estos nuevos conceptos.

Palabras clave:
Gasometría arterial
Trastorno ácido-base
Algoritmo para el análisis de gases arteriales

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