Acid-Base Disorders and Their Treatment PDF

Preface

Over twenty years ago, two of us (Nicolaos E. Madias and F. John Gennari) were fortunate to contribute to writing a unique book, entitled Acid–Base. That book combined a comprehensive review of acid–base physiology and pathophysiology with straightforward clinical applications of the principles derived from this knowledge. Over the ensuing years, our knowledge of acid–base physiology and pathophysiology has changed dramatically, and it became clear that it was time for a new look at this subject. Hence the origin of Acid–Base Disorders.

As we looked at the breadth of this new body of knowledge, we saw that the task was larger than the four of us. To that end, we have recruited a select group of acid–base experts as contributors to the new book. Although now a multi-authored work, we have written many of the chapters ourselves, and have carefully edited the remaining chapters to avoid unnecessary redundancy and ensure a consistency of style throughout the book.

Our goal is to present the normal physiology of acid–base homeostasis as we know it in the early 21st century, and to review current information about the pathophysiology of acid–base disorders from both a molecular and an integrative perspective. Most important, Acid–Base Disorders continues the tradition of Acid–Base by bringing these new experimental observations to the bedside and providing straightforward guidelines for diagnosing and managing disturbances of acid–base homeostasis. A key feature of this new book is to link molecular and cellular information about epithelial transport in the kidney to observations in intact animals and humans in an effort to explain unanswered questions about acid–base physiology and pathophysiology.

The book is divided into seven sections. Section I encompasses normal chemistry and physiology. This section reviews the current state of our knowledge of acid–base chemistry, and includes a discussion of the Stewart approach to analyzing acid–base chemistry in terms of the independent and dependent variables. It reviews recent advances in the molecular biology of renal acid–base transporters, as well as animal and human studies of acid balance, and ends with a novel hypothesis concerning diet and acid–base balance (Chapter 8). Section II is devoted to a comprehensive view of metabolic acidosis, with separate chapters on all the major forms. The controversy concerning whether acid is retained in chronic kidney disease is discussed in Chapter 14. Section III covers metabolic alkalosis, and comes to grips with the roles of chloride, potassium, and extracellular fluid volume in the pathophysiology of this disorder. Section IV reviews our current knowledge of respiratory and mixed acid–base disorders, including the recently described ‘‘pseudorespiratory alkalosis'' that occurs in patients with profound depression of cardiac function. Section V covers the unique nature of acid-balance and acid–base disorders in patients with end-stage renal disease receiving renal replacement therapy. Section VI is devoted to acid–base disorders in infants and children, and Section VII reviews the measurement techniques for diagnosing acid–base disorders, but its main focus is on providing clinical tools for diagnosis, and to demonstrate the use of these tools in diagnosing and managing patients with acid–base disorders using cases culled from our combined experience.

Our goal has been to produce a complete review of this broad topic, directed both to experts in the field, and also to the many clinicians who must deal with acid–base disorders in their daily practice. Our readers will judge whether our goal was accomplished.