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2016 ; 11
(9
): e0162872
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English Wikipedia
Strong Relationships in Acid-Base Chemistry - Modeling Protons Based on
Predictable Concentrations of Strong Ions, Total Weak Acid Concentrations, and
pCO2
#MMPMID27631369
Ring T
; Kellum JA
PLoS One
2016[]; 11
(9
): e0162872
PMID27631369
show ga
Understanding acid-base regulation is often reduced to pigeonholing clinical
states into categories of disorders based on arterial blood sampling. An earlier
ambition to quantitatively explain disorders by measuring production and
elimination of acid has not become standard clinical practice. Seeking back to
classical physical chemistry we propose that in any compartment, the requirement
of electroneutrality leads to a strong relationship between charged moieties.
This relationship is derived in the form of a general equation stating charge
balance, making it possible to calculate [H+] and pH based on all other charged
moieties. Therefore, to validate this construct we investigated a large number of
blood samples from intensive care patients, where both data and pathology is
plentiful, by comparing the measured pH to the modeled pH. We were able to
predict both the mean pattern and the individual fluctuation in pH based on all
other measured charges with a correlation of approximately 90% in individual
patient series. However, there was a shift in pH so that fitted pH in general is
overestimated (95% confidence interval -0.072-0.210) and we examine some
explanations for this shift. Having confirmed the relationship between charged
species we then examine some of the classical and recent literature concerning
the importance of charge balance. We conclude that focusing on the charges which
are predictable such as strong ions and total concentrations of weak acids leads
to new insights with important implications for medicine and physiology.
Importantly this construct should pave the way for quantitative acid-base models
looking into the underlying mechanisms of disorders rather than just classifying
them.