"Most students consider the discussion of physiological acid-base balance a mystery.
This is mainly because of the way the topic has been presented.
At first reading of any text book on acid-base balance they realise that what they are reading
is not consistent with chemistry previously learnt." Michael Bookallil
acid base analysis
While not based on the Stewart approach, the late Michael Bookallil's online book about
acid-base balance is worth while reading, and serves to remember that eccentric Sydney anaesthesiologist
with a mind and a tongue sharp as a razor.
Michael Bookallil's ACIDBASE BALANCE
His account is especially lucid in its discussion of hypothermia
and its significance in acid-base analysis and general physiology.
Stewart type acid-base analysis based sites
There is a splendid book on acid base and fluid physiology by Kerry Brandis,
explaining both the traditional and the physicochemical analysis,
known as the Stewart approach:
acid base and fluid physiology
The physicochemical approach is discussed in detail in chapter 10:
the concept of strong ion difference
This exhaustive site dedicated to the physicochemical approach features
a java based acid base calculator, based on the Stewart approach: IONZ,
authored chiefly by Lara Hopley and Jo van Schalkwyk.
Here you can make clear graphs showing the effects of the different components
on the acidity of a solution.
James Figge, one of the original researchers in this field, closely linked to Peter Stewart's and
Vladimir Fencl's work presents a detailed account of the weak acids, especially albumin and its
experimental validation on the Figge - Fencl - website,
as well as a tribute to the late Vladimir Fencl.
John Kellum of Pittsburgh university is one of the most prominent proponents of the Stewart approach. His web pages give a concise
introduction to the topic with clinical examples and the possibility to download a pH and acidbase calculator spreadsheet. John Kellum's phorum website
The following is a presentation about respiratory physiology, with special regard to respiratory drive
under conditions of height, pregnancy etc., with acid-base considerations based on the Stewart model:
Carriage of oxygen and carbondioxide in blood
The late Peter Lloyd's Stewart-based acid-base calculator and its clinical utility are presented with many
illustrative examples in
Using Quantitative Acid-Base Analysis in the ICU
Peter Lloyd's website offering to download the spreadsheet based calculator mentioned in his publication
can no longer be accessed, though, but we have got permission to put it up for download on our site. this is "what Peter would want",
according to his mother. Please go to the download page to get this spreadsheet calculator and the article about how to use it!
AcidBasics - Part 3 of a fun primer on fluids, electrolytes and acid-base therapy for intensive care professionals, by Tom Woodcock.
3-acid basics
inspite of the often acerbic rethoric, reminiscent of religious controversies, not all is dismal disagreement between the
different approaches to acid-base, though!
base excess centered analysis sites
on the Siggaard-Andersen homepage you will find a rich source of information about acid-base and blood gases:
the Siggaard-Andersen homepage
(go to the sections on "buffer base" and the "van Slyke formula" to see the parallels between the approaches!)
another excellent website about the BE approach (critical of the Stewart approach, even though in a respectful way .... ):
Alan W. Grogono's homepage.
bicarbonate centered analysis sites
there is another excellent website and tutorial about the bicarbonate-based variant of acid-base analysis is
Timur Graham's site
at the University of Connecticut.
the bicarbonate approach, also called the "physiological approach", is well described by Adrogué, even though he has little
good to say about our favourite theory, either:
a recent article by Adrogué
Adrogué HJ, Gennari FJ, Galla JH, Madias NE; Assessing acid-base disorders; Kidney Int 2009 Oct 7
The Border Flux Model
The "BORDER FLUX BALANCE APPROACH TOWARDS MODELLING ACID-BASE CHEMISTRY AND BLOOD GASES TRANSPORT"
by Jirí Kofránek, Stanislav Matousek, Michal Andrlík from Charles University in Prague.
This is a very interesting approach making a synthesis of Stewart type thinking and the bicarbonate centred approach. The theory is explained
in the article about the border flux approach,
an online simulator can be used at the authors' website.
