Author/Editor     Stožer, Andraž; Rupnik, Marjan
Title     Akutna respiracijska acidoza in alkaloza
Translated title     Acute respiratory acidosis and alkalosis
Type     članek
Vol. and No.     Letnik 83, št. 2
Publication year     2014
Volume     str. 147-157
ISSN     1581-0224 - Zdravniški vestnik
Language     slv
Abstract     Izhodišče: Obstajajo trije različni pristopi k oceni kislinsko-baznega stanja bolnika: bostonski, kopenhagenski in Stewartov, ki temeljijo na različnih izmerjenih parametrih. Poleg vnetih debat o tem, kateri od pristopov je boljši, vnaša med študente, raziskovalce in klinike zmedo dejstvo, da med svojim študijem tipično osvojijo le enega od omenjenih pristopov in zato ne morejo v celoti razumeti virov, ki uporabljajo katerega od drugih pristopov, poleg tega pa ne morejo kritično oceniti prednosti in omejitev določenega pristopa. Avtorja v članku predstaviva in opredeliva osnovne parametre, značilne za posamezne pristope, in poudariva razlike in podobnosti med njimi. Posebno pozornost namenjava vprašanju, kako posamezni pristopi ocenjujejo spremembo v koncentraciji plazemskega bikarbonata, do katere pride med primarnimi respiracijskimi spremembami in katerih ustrezno razumevanje je potrebno za pravilno interpretiranje kroničnih respiracijskih in metaboličnih kislinsko-baznih sprememb. Zaključek: Med akutno respiracijsko acidozo se koncentracija bikarbonata zviša in med akutno respiracijsko alkalozo zniža v odvisnosti od moči nebikarbonatnih pufrov. Med akutnimi respiracijskimi motnjami se koncentracija pufrske baze (uporablja jo kopenhagenski pristop), navidezna razlika močnih ionov, efektivna razlika močnih ionov in vrzel močnih ionov (uporablja jih Stewartov pristop) ne spremenijo, anionska vrzel (uporabljata jo bostonski in kopenhagenski pristop) pa se med akutno respiracijsko acidozo zmanjša, med akutno respiracijsko alkalozo pa zveča.Background: Three different approaches for assessing the acid-base status of a patient exist, i.e. the Boston, Copenhagen, and Stewart's approach, and they employ different parameters to assess a given acid-base disturbance. Students, researchers, and clinicians are getting confused by heated debates about which of these performs best and by the fact that during their curricula, they typically get acquainted with one of the approaches only, which prevents them to understand sources employing other approaches and to critically evaluate the advantages and drawbacks of each approach. In this paper, the authors introduce and define the basic parameters characterizing each of the approaches and point out differences and similarities between them. Special attention is devoted to how the different approaches assess the degree of change in the concentration of plasma bicarbonate that occurs during primary respiratory changes; proper understanding of these is necessary to correctly interpret chronic respiratory and metabolic acidbase changes. Conclusion: During acute respiratory acidosis the concentration of bicarbonate rises and during acute respiratory alkalosis it falls, depending on the buffering strength of non-bicarbonate buffers. During acute respiratory acid-base disturbances, buffer base (employed by the Copenhagen approach), apparent and effective strong ion difference, as well as strong ion gap (employed by the Stewart approach) remain unchanged; the anion gap (employed by the Boston and Copenhagen approach) falls during acute respiratory acidosis and rises during acute respiratory alkalosis.
Keywords     Davenportov
Gamblov diagram
kislinsko-bazna motnja
Davenport
Gamble diagram
acid-base disturbance