ArticleIndian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine2022
Utility of Stewart's Approach to Diagnose Missed Complex Acid-Base Disorders as Compared to Bicarbonate-anion Gap-based Methodology in Critically Ill Patients: An Observational Study.
Article in Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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4 citing papers in PubMed, 6 citations in OpenAlex.
- A novel corrected anion gap links metabolic acid attack to peptic ulcer disease.Frontiers in nutrition · 2026Article
- Dialysis and Acid-Base Balance: A Comparative Physiological Analysis of Boston and Stewart Models.Journal of clinical medicine · 2025Article
- Relationship between albumin-corrected anion gap and non-alcoholic fatty liver disease: a cross-sectional analysis of NHANES 2017-2018.Frontiers in medicine · 2025Article
- Revisiting Stewart's Approach toward Assessment of Unidentified or Complex Acid-Base Disorders.Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2022Article
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4 authors at 2 institutions in 2 countries.
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Abstract
backgroundTraditional arterial blood gas (ABG) analysis may miss out on some metabolic acid-base disorders. We prospectively compared Stewart's approach in critically ill patients to traditional bicarbonate-anion gap-based methods (with and without correction for albumin) to diagnose acid-base disorders. PATIENTS AND
methodsFive hundred ABG samples from medical or surgical patients in the ICU were analyzed with traditional bicarbonate-anion gap-based methodology with and without correction for albumin and Stewart's biochemical approach. The primary outcome identification of additional metabolic disorders diagnosed with Stewart's approach in comparison to bicarbonate system-based approaches. We also looked at the correlation between the strong ion gap (SIG) and the albumin-corrected anion gap (acAnion Gap).
resultsStewart's approach detected missed metabolic disorders in 58 (11.6%) blood gas results reported as "within normal limits" with the bicarbonate-uncorrected anion gap approach. In 50 (10%) of these ABGs, the acAnion Gap approach was able to diagnose the missed metabolic disorders. Thus, the albumin-corrected anion gap method had a similar diagnostic performance to Stewart's approach, as it missed additional disorders in only eight (1.6%) blood gases.
conclusionIn this study, we found that the acAnion Gap approach was similar in diagnostic performance to Stewart's approach. We feel that the corrected anion gap approach can be safely used if a ready calculator for Stewart's approach is not available. HOW TO CITE THIS ARTICLE: Paliwal R, Pakavakis A, Divatia JV, Kulkarni AP. Utility of Stewart's Approach to Diagnose Missed Complex Acid-Base Disorders as Compared to Bicarbonate-anion Gap-based Methodology in Critically Ill Patients: An Observational Study. Indian J Crit Care Med 2022;26(1):23-32.
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