Anaes SAQs · Applied cardiovascular & respiratory physiology
The Stewart approach to acid-base
Primary — three independent variables (PaCO2, SID, Atot); SID (sodium minus chloride, about 40); Atot (albumin plus phosphate); bicarbonate as a dependent variable; hyperchloraemic acidosis of saline (low SID); hypoalbuminaemic alkalosis; strong ion gap; balanced crystalloids.
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Prompt
Outline the Stewart (physicochemical) approach to acid-base. Define the strong ion difference and total weak acid, and explain how the Stewart approach accounts for the metabolic acidosis of large-volume saline resuscitation.
Question
Outline the Stewart (physicochemical) approach to acid-base. Define the strong ion difference and total weak acid, and explain how the Stewart approach accounts for the metabolic acidosis of large-volume saline resuscitation. (Question stem restated — the worked answers below carry the primary-source citations.)
References4ShowHide
- [1]Samara EM. Stewart-based characterisation of blood acid-base recovery over 48 h following exercise under hot condition in camels (Camelus dromedarius). Anim Biosci, 2026.PMID 41856088
- [4]Carrigan K, et al. Balanced fluid bolus: Should we prefer balanced crystalloids over "normal" saline? J Perinatol, 2026.PMID 41826663
- [3]de Souza SP, et al. Physico-chemical characterization of acid base disorders in patients with COVID-19: A cohort study. World J Nephrol, 2024.PMID 38983762
- [2]Kroustalakis N, et al. Dialysis and acid-base balance. J Clin Med, 2025.PMID 41303241