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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care
SMART SUMMER SMART 2006 - Milan, May 10-12, 2006
Minerva Anestesiologica 2006 June;72(6):551-7
Respiratory acidosis: is the correction with bicarbonate worth?
Gattinoni L. 1,2, Taccone P. 2, Carlesso E. 1
1 Institute of Anesthesia and Intensive Care University of Milan, Milan, Italy
2 Department of Anesthesia and Intensive Care Fondazione IRCCS, “Ospedale Maggiore Policlinico, Mangiagalli, Regina Elena”, Milan, Italy
Bicarbonate infusion is traditionally used to increase pH during metabolic acidosis, but it has been also suggested to increase the pH during permissive hypercapnia. In this paper we will discuss the physicochemical effect of adding (Na+ HCO3-), first in a closed system (venous blood) and then in an open system (the blood after the lung). According to Stewart model, in the closed system two independent variables are changed (CO2 and strong ion difference). As a first result changes in pH are negligible. If the CO2 is cleared by the lung and the PCO2 is maintained as before the infusion, the rise in pH is due to the SID increase caused by the (Na+) rise. The effect is independent on (HCO3-) infusion and equivalent to adding (Na+OH-) instead of (Na+HCO3-).