Strong Ions, Acid-base, and Crystalloid Design

  • T. J. Morgan
  • B. Venkatesh


It is now generally accepted that whenever large volumes of saline are administered intravenously, metabolic acidosis can result [1–3]. Examples of at risk situations include acute normovolemic hemodilution, cardiopulmonary bypass, hypovolemic and septic shock, multitrauma, burns, liver transplantation, diabetic ketoacidosis and hyperosmolar non-ketotic coma. The conventional explanation is that there is simple dilution of extracellular bicarbonate (HCO 3 ) by large volumes of non-HCO 3 containing fluid [4–7]. However, Stewart’s physical-chemical approach to acid-base analysis provides a different perspective. In this chapter, we will see how Stewart’s concepts might assist in the design of crystalloid solutions with predetermined acid-base effects. We will begin by reviewing some important principles of acid-base analysis with an emphasis on the physical-chemical approach.


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© Springer Science+Business Media New York 2002

Authors and Affiliations

  • T. J. Morgan
  • B. Venkatesh

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