1. ¹Department of Medicine, Baylor College of Medicine, Houston, TX, USA
2. ²Department of Medicine, Methodist Hospital, Houston, TX, USA
3. ³Renal Section, Veterans Affairs Medical Center, Houston, TX, USA
4. ⁴Department of Medicine, University of Vermont College of Medicine, Burlington, VT, USA
5. ⁵Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
6. ⁶Department of Medicine, Tufts University School of Medicine, Boston, MA, USA
7. ⁷Division of Nephrology, Department of Medicine, Caritas St Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA, USA

Correspondence: Nicolaos E. Madias, Department of Medicine, Caritas St Elizabeth's Medical Center, 736 Cambridge Street, Boston, MA 02135, USA. E-mail: nicolaos.madias@caritaschristi.org

Received 24 June 2009; Revised 14 July 2009; Accepted 14 July 2009; Published online 7 October 2009.

Abstract

Effective management of acid–base disorders depends on accurate diagnosis. Three distinct approaches are currently used in assessing acid–base disorders: the physiological approach, the base-excess approach, and the physicochemical approach. There are considerable differences among the three approaches. In this review, we first describe the conceptual framework of each approach, and comment on its attributes and drawbacks. We then highlight the application of each approach to patient care. We conclude with a brief synthesis and our recommendations for choosing an approach.