Table 2

Disease states classified according to the Stewart approach

Acid–base disturbance
Disease state
Examples

Metabolic alkalosis
Low serum albumin
Nephrotic syndrome, hepatic cirrhosis

High SID+
Chloride loss: vomiting, gastric drainage, diuretics, post-hypercapnea, Cl- wasting diarrhea due to villous adenoma, mineralocorticoid excess, Cushing's syndrome, Liddle's syndrome, Bartter's syndrome, exogenous corticosteroids, licorice Na2+ load (such as acetate, citrate, lactate): Ringer's solution, TPN, blood transfusion
Metabolic acidosis
Low SID+ and high SIG
Ketoacids, lactic acid, salicylate, formate, methanol

Low SID+ and low SIG
RTA, TPN, saline, anion exchange resins, diarrhea, pancreatic losses

RTA, renal tubular acidosis; SIG, strong ion gap; SID+, strong ion difference; TPN, total parenteral nutrition.

Corey Critical Care 2005 9:184   doi:10.1186/cc2985