ArticleIntensive care medicine2011
The rule regulating pH changes during crystalloid infusion.
Article in Intensive care medicine, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers.
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Who cites it
19 citing papers in PubMed.
- Reply to: Effective buffers in intravenous solutions: reconciling the acid-base effects of organic anions.Critical care (London, England) · 2026Article
- Plasma Bicarbonate as a Determinant of Fluid-Induced Acid-Base Changes in Postoperative Critically Ill Patients: A Retrospective Analysis.Journal of clinical medicine · 2026Article
- Effective buffers in intravenous solutions: reconciling the acid-base effects of organic anions.Critical care (London, England) · 2026Article
- Fluid-induced acid-base variations in postoperative critically ill patients: physiological determinants and renal response.Frontiers in medicine · 2026Article
- Stewart's theory and acid-base changes induced by crystalloid infusion in humans: a randomized physiological trial.Annals of intensive care · 2025Article
- Evaluation of the clinical characteristics and outcomes of patients admitted to intensive care units after the Kahramanmaras (Türkiye) earthquake: a multicenter observational study.Frontiers in medicine · 2025Article
- Role of Crystalloids in the Perioperative Setting: From Basics to Clinical Applications and Enhanced Recovery Protocols.Journal of clinical medicine · 2023Review
- A review of adult resuscitative fluid purchasing and usage trends at an academic tertiary hospital in Johannesburg.Anaesthesiology intensive therapy · 2022Article
- Fluid Stewardship During Critical Illness: A Call to Action.Journal of pharmacy practice · 2020Article
- Intravenous fluid therapy in the perioperative and critical care setting: Executive summary of the International Fluid Academy (IFA).Annals of intensive care · 2020Review
- 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
- Effect of Intravenously Administered Crystalloid Solutions on Acid-Base Balance in Domestic Animals.Journal of veterinary internal medicine · 2017Review
- Fluid and electrolyte overload in critically ill patients: An overview.World journal of critical care medicine · 2015Review
- Supporting hemodynamics: what should we target? What treatments should we use?Critical care (London, England) · 2013Review
- Year in review in Intensive Care Medicine 2011: III. ARDS and ECMO, weaning, mechanical ventilation, noninvasive ventilation, pediatrics and miscellanea.Intensive care medicine · 2012Review
- In vivo conditioning of acid-base equilibrium by crystalloid solutions: an experimental study on pigs.Intensive care medicine · 2012Article
- Isotonic saline--the only solution to recommend?Critical care (London, England) · 2011Article
- 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
Corrections and comments
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Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeTo define the rule according to which crystalloid solutions characterized by different strong ion difference (SID) modify the acid-base variables of human plasma.
methodsWith a previously validated software, we computed the effects of diluting human plasma with crystalloid solutions ([SID] 0-60, 10 mEq/l stepwise). An equation was derived to compute the diluent [SID] required to maintain the baseline pH unchanged, at constant PCO₂ and at every dilution fraction. The results were experimentally tested using fresh frozen plasma, re-warmed at 37°C, equilibrated at PCO₂ 35 and 78 mmHg, at baseline and after the infusion of crystalloid solutions with 0, 12, 24, 36, 48 mEq/l [SID].
resultsThe mathematical analysis showed that the diluent [SID] required to maintain unmodified the baseline pH equals the baseline bicarbonate concentration, [HCO₃⁻], assuming constant PCO₂ throughout the process. The experimental data confirmed the theoretical analysis. In fact, at the baseline [HCO₃⁻] of 18.3 ± 0.3 mmol/l (PCO₂ 35 mmHg) the pH was 7.332 ± 0.004 and remained 7.333 ± 0.003 when the diluting [SID] was 18.5 ± 0.0 mEq/l. At baseline [HCO₃⁻] of 19.5 ± 0.3 mmol/l (PCO₂ 78 mmHg) the pH was 7.010 ± 0.003 and remained 7.004 ± 0.003 when the diluting [SID] was 19.1 ± 0.1 mEq/l. At both PCO₂ values infusion with [SID] lower or greater than baseline [HCO₃⁻] led pH to decrease or increase, respectively.
conclusionsThe baseline [HCO₃⁻] dictates the pH response to crystalloid infusion. If a crystalloid [SID] equals baseline [HCO₃⁻], pH remains unchanged at constant PCO₂, whereas it increases or decreases if the [SID] is greater or lower, respectively.
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Registered trials
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