{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,17]],"date-time":"2025-09-17T00:05:55Z","timestamp":1758067555986,"version":"3.44.0"},"reference-count":38,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-017"},{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-037"},{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-012"},{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-029"},{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-004"}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","jem-journal.com","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["The Journal of Emergency Medicine"],"published-print":{"date-parts":[[2025,10]]},"DOI":"10.1016\/j.jemermed.2025.07.021","type":"journal-article","created":{"date-parts":[[2025,7,16]],"date-time":"2025-07-16T00:40:09Z","timestamp":1752626409000},"page":"50-60","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":0,"special_numbering":"C","title":["Quantitative Acid-Base: A Simplified Approach for the Emergency Physician"],"prefix":"10.1016","volume":"77","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7105-3885","authenticated-orcid":false,"given":"Rory","family":"Spiegel","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Gordon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shane","family":"Kappler","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Max","family":"Hockstein","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"78","reference":[{"key":"10.1016\/j.jemermed.2025.07.021_bib0001","doi-asserted-by":"crossref","first-page":"789","DOI":"10.1097\/00000542-195911000-00007","article-title":"Apneic oxygenation in man","volume":"20","author":"Frumin","year":"1959","journal-title":"Anesthesiology"},{"key":"10.1016\/j.jemermed.2025.07.021_bib0002","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1186\/s13054-015-0896-7","article-title":"Hemodynamic consequences of severe lactic acidosis in shock states: from bench to bedside","volume":"19","author":"Kimmoun","year":"2015","journal-title":"Crit Care"},{"key":"10.1016\/j.jemermed.2025.07.021_bib0003","doi-asserted-by":"crossref","DOI":"10.1097\/CCM.0000000000002730","article-title":"Relationship of at admission lactate, unmeasured anions, and chloride to the outcome of critically ill patients","volume":"45","author":"Masevicius","year":"2017","journal-title":"Crit Care Med"},{"key":"10.1016\/j.jemermed.2025.07.021_bib0004","doi-asserted-by":"crossref","first-page":"178","DOI":"10.4103\/2229-5151.195417","article-title":"A profile of metabolic acidosis in patients with sepsis in an Intensive Care Unit setting","volume":"6","author":"Ganesh","year":"2016","journal-title":"Int J Crit Illn Inj Sci"},{"key":"10.1016\/j.jemermed.2025.07.021_bib0005","doi-asserted-by":"crossref","DOI":"10.1155\/2015\/134780","article-title":"Severe ketoacidosis (pH \u2264 6.9) in type 2 diabetes: more frequent and less ominous than previously thought","volume":"2015","author":"Rodr\u00edguez-Guti\u00e9rrez","year":"2015","journal-title":"Biomed Res Int"},{"key":"10.1016\/j.jemermed.2025.07.021_bib0006","doi-asserted-by":"crossref","first-page":"492","DOI":"10.7326\/0003-4819-112-7-492","article-title":"Bicarbonate does not improve hemodynamics in critically III patients who have lactic acidosis","volume":"112","author":"Cooper","year":"1990","journal-title":"Ann Intern Med"},{"key":"10.1016\/j.jemermed.2025.07.021_bib0007","doi-asserted-by":"crossref","first-page":"1352","DOI":"10.1097\/00003246-199111000-00008","article-title":"Effects of bicarbonate therapy on hemodynamics and tissue oxygenation in patients with lactic acidosis: a prospective, controlled clinical study","volume":"19","author":"Mathieu","year":"1991","journal-title":"Crit Care Med"},{"key":"10.1016\/j.jemermed.2025.07.021_bib0008","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/S0140-6736(18)31080-8","article-title":"Sodium bicarbonate therapy for patients with severe metabolic acidaemia in the intensive care unit (BICAR-ICU): a multicentre, open-label, randomised controlled, phase 3 trial","volume":"392","author":"Jaber","year":"2018","journal-title":"Lancet"},{"year":"2016","series-title":"Nunn's Applied Respiratory Physiology","author":"Lumb","key":"10.1016\/j.jemermed.2025.07.021_bib0009"},{"key":"10.1016\/j.jemermed.2025.07.021_bib0010","doi-asserted-by":"crossref","DOI":"10.1016\/B978-0-323-44942-7.00065-0","article-title":"Acid-base physiology and diagnosis of disorders","volume":"65","author":"Ring","year":"2019","journal-title":"Critical Care Nephrology"},{"key":"10.1016\/j.jemermed.2025.07.021_bib0011","doi-asserted-by":"crossref","first-page":"1709","DOI":"10.1001\/jama.2024.15815","article-title":"Effect of high-intensity vs low-intensity noninvasive positive pressure ventilation on the need for endotracheal intubation in patients with an acute exacerbation of chronic obstructive pulmonary disease: the HAPPEN randomized clinical trial","volume":"332","author":"Luo","year":"2024","journal-title":"JAMA"},{"key":"10.1016\/j.jemermed.2025.07.021_bib0012","doi-asserted-by":"crossref","first-page":"312","DOI":"10.7326\/0003-4819-66-2-312","article-title":"Quantitative displacement of acid-base equilibrium in metabolic acidosis","volume":"66","author":"Albert","year":"1967","journal-title":"Ann Intern Med"},{"key":"10.1016\/j.jemermed.2025.07.021_bib0013","article-title":"Metabolic acidosis","volume":"66","author":"Zampieri","year":"2017","journal-title":"Critical Care Nephrology"},{"key":"10.1016\/j.jemermed.2025.07.021_bib0014","doi-asserted-by":"crossref","DOI":"10.1016\/B978-0-323-44942-7.00068-6","article-title":"Renal tubular acidosis","volume":"68","author":"Corey","year":"2019","journal-title":"Critical Care Nephrology"},{"key":"10.1016\/j.jemermed.2025.07.021_bib0015","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1186\/cc2946","article-title":"The meaning of acid-base abnormalities in the intensive care unit: part III \u2013 effects of fluid administration","volume":"9","author":"Morgan","year":"2005","journal-title":"Crit Care"},{"key":"10.1016\/j.jemermed.2025.07.021_bib0016","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1016\/S2213-2600(23)00417-4","article-title":"Balanced crystalloids versus saline for critically ill patients (BEST-Living): a systematic review and individual patient data meta-analysis","volume":"12","author":"Zampieri","year":"2024","journal-title":"Lancet Respir Med"},{"key":"10.1016\/j.jemermed.2025.07.021_bib0017","doi-asserted-by":"crossref","first-page":"1170","DOI":"10.1016\/j.amjmed.2021.03.017","article-title":"Pseudohyperchloremia and negative anion gap \u2013 think salicylate!","volume":"134","author":"Wiederkehr","year":"2021","journal-title":"Am J Med"},{"key":"10.1016\/j.jemermed.2025.07.021_bib0018","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1159\/000168457","article-title":"Spurious hyperchloremia and decreased anion gap in a patient with dextromethorphan bromide","volume":"12","author":"Ng","year":"1992","journal-title":"Am J Nephrol"},{"key":"10.1016\/j.jemermed.2025.07.021_bib0019","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1056\/NEJMra1615295","article-title":"Toxic alcohols","volume":"378","author":"Kraut","year":"2018","journal-title":"N Engl J Med"},{"key":"10.1016\/j.jemermed.2025.07.021_bib0020","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1002\/(SICI)1520-7560(199911\/12)15:6<412::AID-DMRR72>3.0.CO;2-8","article-title":"Ketone bodies: a review of physiology, pathophysiology and application of monitoring to diabetes","volume":"15","author":"Laffel","year":"1999","journal-title":"Diabetes Metab Res Rev"},{"key":"10.1016\/j.jemermed.2025.07.021_bib0021","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ejogrb.2012.10.005","article-title":"Starvation ketoacidosis in pregnancy","volume":"167","author":"Frise","year":"2013","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"10.1016\/j.jemermed.2025.07.021_bib0022","doi-asserted-by":"crossref","unstructured":"London V, Grube S, Sherer DM, Abulafia O Hyperemesis gravidarum: a review of recent literature pharmacology. 2017; 100:161\u2013171.","DOI":"10.1159\/000477853"},{"key":"10.1016\/j.jemermed.2025.07.021_bib0023","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1136\/emj.2004.017590","article-title":"Alcoholic ketoacidosis","volume":"23","author":"McGuire","year":"2006","journal-title":"Emerg Med J"},{"issue":"2","key":"10.1016\/j.jemermed.2025.07.021_bib0024","first-page":"e4086","article-title":"Isolated starvation ketoacidosis: a rare cause of severe metabolic acidosis presenting with a pH less than 7","volume":"11","author":"Mubarik","year":"2019","journal-title":"Cureus"},{"key":"10.1016\/j.jemermed.2025.07.021_bib0025","doi-asserted-by":"crossref","unstructured":"Rodr\u00edguez-Guti\u00e9rrez R, C\u00e1mara-Lemarroy CR, Quintanilla-Flores DL, et al. Severe ketoacidosis (pH \u2264 6.9) in type 2 diabetes: more frequent and less ominous than previously thought BioMed Research International. 2015; 2015:1\u20135.","DOI":"10.1155\/2015\/134780"},{"key":"10.1016\/j.jemermed.2025.07.021_bib0026","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1186\/2050-6511-14-22","article-title":"The prognostic value of blood pH and lactate and metformin concentrations in severe metformin-associated lactic acidosis","volume":"14","author":"Kajbaf","year":"2013","journal-title":"BMC Pharmacol Toxicol"},{"key":"10.1016\/j.jemermed.2025.07.021_bib0027","doi-asserted-by":"crossref","first-page":"R226","DOI":"10.1186\/cc9376","article-title":"Outcome of severe lactic acidosis associated with metformin accumulation","volume":"14","author":"Friesecke","year":"2010","journal-title":"Crit Care"},{"key":"10.1016\/j.jemermed.2025.07.021_bib0028","doi-asserted-by":"crossref","first-page":"1432","DOI":"10.1016\/j.metabol.2016.05.014","article-title":"Corrigendum to \u201cmetformin-associated lactic acidosis: current perspectives on causes and risk\u201d [Metabolism 65 (2016) 20\u201329]","volume":"65","author":"DeFronzo","year":"2016","journal-title":"Metabolism"},{"key":"10.1016\/j.jemermed.2025.07.021_bib0029","doi-asserted-by":"crossref","unstructured":"Chang TP, Rangan C Iron poisoning pediatric emergency care. 2011; 27:978\u2013985.","DOI":"10.1097\/PEC.0b013e3182302604"},{"key":"10.1016\/j.jemermed.2025.07.021_bib0030","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1182\/blood.V10.1.46.46","article-title":"Acute intestinal iron intoxication. II. Metabolic, respiratory and circulatory effects of absorbed iron salts","volume":"10","author":"Reissmann","year":"1955","journal-title":"Blood"},{"key":"10.1016\/j.jemermed.2025.07.021_bib0031","first-page":"749","article-title":"Isoniazid overdose: recognition and management","volume":"57","author":"Romero","year":"1998","journal-title":"Am Fam Physician"},{"key":"10.1016\/j.jemermed.2025.07.021_bib0032","series-title":"Gyromitra Mushroom Toxicity","article-title":"StatPearls","author":"Horowitz","year":"2024"},{"key":"10.1016\/j.jemermed.2025.07.021_bib0033","doi-asserted-by":"crossref","first-page":"2309","DOI":"10.1056\/NEJMra1309483","article-title":"Lactic acidosis","volume":"371","author":"Kraut","year":"2014","journal-title":"N Engl J Med"},{"key":"10.1016\/j.jemermed.2025.07.021_bib0034","first-page":"21","article-title":"Erratum to: hemodynamic consequences of severe lactic acidosis in shock states: from bench to bedside","author":"Kimmoun","year":"2017","journal-title":"Crit Care"},{"key":"10.1016\/j.jemermed.2025.07.021_bib0035","doi-asserted-by":"crossref","unstructured":"Suetrong B, Walley KR Lactic acidosis in sepsis: it\u2019s not all Anaerobic chest. 2016; 149:252\u2013261.","DOI":"10.1378\/chest.15-1703"},{"key":"10.1016\/j.jemermed.2025.07.021_bib0036","doi-asserted-by":"crossref","first-page":"1164","DOI":"10.1016\/j.clinbiochem.2017.07.008","article-title":"Low sensitivity of anion gap to detect clinically significant lactic acidosis in the emergency department","volume":"50","author":"Xu","year":"2017","journal-title":"Clin Biochem"},{"key":"10.1016\/j.jemermed.2025.07.021_bib0037","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1542\/peds.62.5S.873","article-title":"Pathophysiology of aspirin overdosage toxicity, with implications for management","volume":"62","author":"Temple","year":"1978","journal-title":"Pediatrics"},{"issue":"7","key":"10.1016\/j.jemermed.2025.07.021_bib0038","first-page":"e5229","article-title":"Pyroglutamic acidemia: an underrecognized and underdiagnosed cause of high anion gap metabolic acidosis - A case report and review of literature","volume":"11","author":"Venkataraman","year":"2019","journal-title":"Cureus"}],"container-title":["The Journal of Emergency Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0736467925002732?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0736467925002732?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2025,9,16]],"date-time":"2025-09-16T22:04:53Z","timestamp":1758060293000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0736467925002732"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10]]},"references-count":38,"alternative-id":["S0736467925002732"],"URL":"https:\/\/doi.org\/10.1016\/j.jemermed.2025.07.021","relation":{},"ISSN":["0736-4679"],"issn-type":[{"type":"print","value":"0736-4679"}],"subject":[],"published":{"date-parts":[[2025,10]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Quantitative Acid-Base: A Simplified Approach for the Emergency Physician","name":"articletitle","label":"Article Title"},{"value":"The Journal of Emergency Medicine","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.jemermed.2025.07.021","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2025 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.","name":"copyright","label":"Copyright"}]}}