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Praktische Diagnostik des Säure-Base-Haushalts

Teil 2: Differenzierung von metabolischen Störungen

Practical diagnostics of acid-base disorders

Part II: Complex metabolic disturbances

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An Erratum to this article was published on 15 March 2013

Zusammenfassung

Diese zweiteilige Übersicht gibt einen Überblick über das vorhandene Instrumentarium zur Diagnostik des Säure-Base-Haushalts. Eingegangen wird auf den „traditionellen“ Ansatz, vertreten durch die von Siggaard-Andersen geprägte Kopenhagener Schule und durch die sog. Bostoner Schule, sowie auf den als „modern“ bezeichneten Stewart-Ansatz. Ein zentraler Schwerpunkt liegt darin, für den praktisch tätigen Kliniker eine Vorgehensweise anzubieten, die die Vorzüge aller 3 Ansätze integriert. Im vorliegenden zweiten Teil werden v. a. die Grundlagen der Differenzierung metabolischer Störungen mithilfe des Stewart-Ansatzes beschrieben. Helfen sollen hierbei ein einfacher Algorithmus und ein Kalkulator.

Abstract

The second part of this overview focuses on how to assess more complex metabolic causes of acid-base imbalance. This is precisely the battlefield where most of the fiery debates between the Copenhagen, the Boston and the Stewart schools aroused. While the first part of the overview merged the practical strengths of the three different approaches, in part II it will be shown how the Stewart approach in particular helps in understanding complex metabolic acid base disorders with emphasis on the often underrated role of chloride ions or the weak acid albumin. With the Stewart diagnostic approach in mind the practitioner might wish considering therapeutic options that differ from what is suggested by the more traditional approaches. The specific diagnostic steps are integrated into a simplified algorithm and an acid-base calculator is provided.

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  1. Klinik für Anästhesiologie und Operative Intensivmedizin, Klinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland

    P. Deetjen & M. Lichtwarck-Aschoff

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  1. P. Deetjen
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  2. M. Lichtwarck-Aschoff
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Correspondence to P. Deetjen.

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Deetjen, P., Lichtwarck-Aschoff, M. Praktische Diagnostik des Säure-Base-Haushalts. Anaesthesist 61, 1067–1078 (2012). https://doi.org/10.1007/s00101-012-2101-6

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