ArticleIntensive care medicine2009
Dilutional acidosis: where do the protons come from?
Article in Intensive care medicine, 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 1 of them a synthesis that pooled it.
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Who cites it
19 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Balanced crystalloid solutions versus normal saline in intensive care units: a systematic review and meta-analysis.International urology and nephrology · 2023Pooled it
- Cellular and Molecular Mechanisms of Hemorrhagic Shock: Biological Rationale for Individualized Fluid Resuscitation Strategies and Multimodal Monitoring.Biomedicines · 2026Review
- Effect of mannitol on diuresis and acid-base equilibrium in critically ill patients.Intensive care medicine experimental · 2025Article
- Stewart's theory and acid-base changes induced by crystalloid infusion in humans: a randomized physiological trial.Annals of intensive care · 2025Article
- The Impact of Intravenous Fluid Therapy on Acid-Base Status of Critically Ill Adults: A Stewart Approach-Based Perspective.International journal of nephrology and renovascular disease · 2020Review
- Crystalloid fluid choice in the critically ill : Current knowledge and critical appraisal.Wiener klinische Wochenschrift · 2018Review
- Intravenous fluids: balancing solutions.Journal of nephrology · 2017Review
- Transient dilutional acidosis but no lactic acidosis upon cardiopulmonary bypass in patients undergoing coronary artery bypass grafting.Archives of medical science : AMS · 2017Article
- Impact of chloride and strong ion difference on ICU and hospital mortality in a mixed intensive care population.Annals of intensive care · 2016Article
- Fluid and electrolyte overload in critically ill patients: An overview.World journal of critical care medicine · 2015Review
- Has Stewart approach improved our ability to diagnose acid-base disorders in critically ill patients?World journal of critical care medicine · 2015Review
- Evaporation of free water causes concentrational alkalosis in vitro.Wiener klinische Wochenschrift · 2014Article
- Supporting hemodynamics: what should we target? What treatments should we use?Critical care (London, England) · 2013Review
- In vivo conditioning of acid-base equilibrium by crystalloid solutions: an experimental study on pigs.Intensive care medicine · 2012Article
- The rule regulating pH changes during crystalloid infusion.Intensive care medicine · 2011Article
- Dilutional acidosis: is there a role for the strong ion difference?Intensive care medicine · 2010Article
- Year in review in Intensive Care Medicine 2009: I. Pneumonia and infections, sepsis, outcome, acute renal failure and acid base, nutrition and glycaemic control.Intensive care medicine · 2010Review
- Dilutional acidosis or uncovered cellular metabolism?Intensive care medicine · 2009Article
- Effects of an Iso-Osmotic Chloride-Free Solution With High Strong Ion Difference vs. Ringer's Lactate on Non-Lactate Metabolic Acidosis in Dogs.Journal of veterinary internal medicineArticle
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeTo investigate the mechanism of acidosis developing after saline infusion (dilutional acidosis or hyperchloremic acidosis).
methodsWe simulated normal extracellular fluid dilution by infusing distilled water, normal saline and lactated Ringer's solution. Simulations were performed either in a closed system or in a system open to alveolar gases using software based on the standard laws of mass action and mass conservation. In vitro experiments diluting human plasma were performed to validate the model.
resultsIn our computerized model with constant pKs, diluting extracellular fluid modeled as a closed system with distilled water, normal saline or lactated Ringer's solution is not associated with any pH modification, since all its determinants (strong ion difference, CO(2) content and weak acid concentration) decrease at the same degree, maintaining their relative proportions unchanged. Experimental data confirmed the simulation results for normal saline and lactated Ringer's solution, whereas distilled water dilution caused pH to increase. This is due to the increase of carbonic pK induced by the dramatic decrease of ionic strength. Acidosis developed only when the system was open to gases due to the increased CO(2) content, both in its dissociated (bicarbonate) and undissociated form (dissolved CO(2)).
conclusionsThe increase in proton concentration observed after dilution of the extracellular system derives from the reaction of CO(2) hydration, which occurs only when the system is open to the gases. Both Stewart's approach and the traditional approach may account for these results.
Indexed as
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19763537What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.