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Clinical reviews
THE ACID-BASE EFFECTS OF ALBUMIN IN SEPSIS: RECONCILING THE STEWART PHYSICOCHEMICAL APPROACH WITH THE TRADITIONAL BUFFER-BASE PARADIGM
Department of Anesthesia and Intensive Care Medicine, 'Santa Maria della Misericordia' Udine University Hospital; Department of Medicine, University of Udine
PDF19 pages3.6 MB
Albumin administration in sepsis and septic shock remains controversial due to uncertain clinical benefits and complex acid–base effects. The review discusses how albumin influences acid–base equilibrium through its effects on chloride balance, strong ion difference, and buffering systems. It contrasts the traditional paradigm, where albumin is viewed primarily as a non-bicarbonate plasma buffer, with the Stewart framework, which considers albumin as a weak non-volatile acid affecting hydrogen ion dissociation and pH regulation. The paper emphasizes the implications of these mechanisms in clinical practice, particularly during mechanical ventilation and fluid resuscitation in septic patients.
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