Acidemia: Good, Bad or Inconsequential?

  • J. A. Kellum, M. Song, S. Subramanian Yearbook of Intensive Care and Emergency Medicine 2002 pp 510-516 Acidemia: Good ,Bad or Inconsequential? ABSTRACT ” Despite significant advances in the understanding of cellular physiology and acid-base chemistry, and despite progress in the treatment of acid-base disorders, a central clinical question remains unanswered: Is acidemia harmful? To address this question we will consider both theory and evidence. Acid-base theory is important because it impacts greatly on the interpretation of the limited clinical, epidemiologic, and experimental evidence. It is also important because most clinicians fail to understand or apply basic physical-chemical principles.

Physiological effects of hyperchloraemia and acidosis

J. M. Handy, N. Soni

BJA: British Journal of Anaesthesia, Volume 101, Issue 2, August 2008, Pages 141–150,     Published: 04 June 2008……Significant snippets to be aware of re: this topic!!!!!!…clinical application of in vitro data is flawed. In nature, acidosis inevitably results in an integrated host response that encompasses far more than the metabolic functions of the cell…….Teleology…

Acidosis is a common occurrence in mammals. Indeed, any burst of exercise results in an acidosis and the ability of mammals to recover from extreme exercise and from pathophysiological acidosis of respiratory and metabolic origin is impressive…… ……Although the disease state may be different, there is little doubt that normal mammalian physiology is designed to deal with acidosis, at least initially. It is worth considering this approach further through the rigorously studied model of exercise physiology……. the combined effects of acidosis concurrent with associated metabolic alterations in the whole organism may be markedly different from those seen in isolated preparations……….Exercise: a physiological model of acidosis…….

Please read posts about the importance of measuring minute ventilation in all patients, especially when depressed or psychotic or during quiet delirium or perhaps even delirium. This is the only marker of “Control of Breathing” adaptations.

1] We have a potential new 2 step biomarker for bipolar illness. Ventilatory issues and [hidden] hypercapnia can cause specific patterns of “odd behaviour”, mood and locomotor activity.


No one knows how prevalent respiratory hypercapnia depression due to acquired or congenital causes, is in the neurological or neuropsychiatric or heart failure population.

No one knows when too fast breathing is insufficient [this is why respiratory rate is not enough, need tidal volume as well.

This will also help to understand when academia and/or hypercapnia is harmful or not…..

to be continued.


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