Presentation Description / Summary: It was around 50 years ago when Peter Stewart, Canadian physiologist and uber-nerd, published his seminal work "Independent and Dependent Variables of Acid-Base Control" and turned the bicarbonate-centered world of acid-base analysis on its head. He proposed that the traditional "Boston" and "Copenhagen" approaches to acid-base, which propose that blood pH is largely controlled by changes in bicarbonate (metabolic) and carbon dioxide (respiratory) levels, are partially incorrect and very incomplete. Stewart argued that there are precisely THREE independent variables that actually alter pH of blood, and bicarbonate isn't one of them! In fact, he shows, it is changes in the strong ions, especially sodium and chloride levels, in the plasma that cause changes in bicarbonate levels. We will go over the utterly riveting history of acid-base analysis, then look at a simplified step-by-step approach to characterizing acid-base abnormalities in patients, and finish by using a standard blood chemistry to quickly and accurately, with no fancy math or complicated techniques, correct many of the abnormalities simply by picking the correct IV crystalloid fluid.
Learning Objectives:
Is bicarbonate concentration actually a deteminant of acid-base balance, or simply a downstream consequence consequence of acid base abnormalities? Compare contrast the physiochemical ("Stewart") approach to the "Boston" and "Copenhagen" bicarbonate-centered approach, and evaluate if
Use the Stewart's three independent variable to analyze acid-base data from clinical cases, and fully characterize simple and complex derangements.
Create a fluid therapy plan for small and large animal patients using strong ion difference to correct metabolic acid-base abnormalities.
