{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T12:16:49Z","timestamp":1765541809220,"version":"3.48.0"},"reference-count":29,"publisher":"Walter de Gruyter GmbH","issue":"2-3","license":[{"start":{"date-parts":[[2025,3,1]],"date-time":"2025-03-01T00:00:00Z","timestamp":1740787200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,5,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"j_jbcpp-2025-0016_abs_001\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The study focuses exclusively on the results of an arterial blood gas report, which reveal a phenomenal contradiction if one follows the physiological and physicochemical approaches as well as the standard base excess determination to interpret an acid\u2013base disturbance. The aim of this article is not to fully describe a clinical case and make a differential diagnosis but to analyze the blood gas report data in detail and present the conclusions that result from the application of the different approaches that exist for the interpretation of acid\u2013base disorders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_jbcpp-2025-0016_abs_002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The results of an arterial blood gas report of a patient with severe lactic acidosis were cross-examined using the standard base excess method and the physiologic and physiochemical approaches. The causes of the contradiction are discussed with a commentary on the underlying pathophysiology.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_jbcpp-2025-0016_abs_003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The study revealed the presence of a normal anion gap (even after correction for albumin levels), a slightly increased strong ion gap and a moderately decreased standard base excess in a patient with severe lactic acidosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_jbcpp-2025-0016_abs_004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This real-life case provides an opportunity to give a brief overview of the current methods for investigating acid\u2013base disturbances in a practical way, emphasizing both the common background and the conceptual differences and similarities.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1515\/jbcpp-2025-0016","type":"journal-article","created":{"date-parts":[[2025,3,29]],"date-time":"2025-03-29T00:58:22Z","timestamp":1743209902000},"page":"229-235","source":"Crossref","is-referenced-by-count":0,"title":["Approaching a phenomenal contradiction in acid\u2013base physiology"],"prefix":"10.1515","volume":"36","author":[{"given":"Stelios","family":"Kokkoris","sequence":"first","affiliation":[{"name":"1st Critical Care Department , National and Kapodistrian University of Athens, Evangelismos Hospital , Athens , Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kyriakos","family":"Trigkidis","sequence":"additional","affiliation":[{"name":"1st Critical Care Department , National and Kapodistrian University of Athens, Evangelismos Hospital , Athens , Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dimitrios-Dorotheos","family":"Papadakis","sequence":"additional","affiliation":[{"name":"Pathophysiology Department, Medical School , National and Kapodistrian University of Athens , Athens , Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dimitrios","family":"Kostarakis","sequence":"additional","affiliation":[{"name":"1st Critical Care Department , National and Kapodistrian University of Athens, Evangelismos Hospital , Athens , Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nikolaos","family":"Gialelis","sequence":"additional","affiliation":[{"name":"1st Critical Care Department , National and Kapodistrian University of Athens, Evangelismos Hospital , Athens , Greece"},{"name":"Department of Mathematics , National and Kapodistrian University of Athens , Athens , Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9529-9361","authenticated-orcid":false,"given":"Ioannis","family":"Vasileiadis","sequence":"additional","affiliation":[{"name":"1st Critical Care Department , National and Kapodistrian University of Athens, Evangelismos Hospital , Athens , Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"374","published-online":{"date-parts":[[2025,3,31]]},"reference":[{"key":"2025121209195975713_j_jbcpp-2025-0016_ref_001","doi-asserted-by":"crossref","unstructured":"Mallat, J, Barrailler, S, Lemyze, M, Pepy, F, Gasan, G, Tronchon, L, et al.. Use of sodium-chloride difference and corrected anion gap as surrogates of Stewart variables in critically ill patients. PLoS One 2013;8:e56635. https:\/\/doi.org\/10.1371\/journal.pone.0056635.","DOI":"10.1371\/journal.pone.0056635"},{"key":"2025121209195975713_j_jbcpp-2025-0016_ref_002","unstructured":"Marano, M, Jain, D, Aggarwal, HK, Izzo, F. Evaluation of expected ventilatory response to metabolic acidosis in severely ill patients. J\u00a0Assoc Phys India 2021;69:11\u201312."},{"key":"2025121209195975713_j_jbcpp-2025-0016_ref_003","doi-asserted-by":"crossref","unstructured":"Berend, K, de Vries, APJ, Gans, ROB. Physiological approach to assessment of acid-base disturbances. N\u00a0Engl J Med 2014;371:1434\u201345. https:\/\/doi.org\/10.1056\/NEJMra1003327.","DOI":"10.1056\/NEJMra1003327"},{"key":"2025121209195975713_j_jbcpp-2025-0016_ref_004","doi-asserted-by":"crossref","unstructured":"Figge, J, Jabor, A, Kazda, A, Fencl, V. Anion gap and hypoalbuminemia. Crit Care Med 1998;26:1807\u201310. https:\/\/doi.org\/10.1097\/00003246-199811000-00019.","DOI":"10.1097\/00003246-199811000-00019"},{"key":"2025121209195975713_j_jbcpp-2025-0016_ref_005","doi-asserted-by":"crossref","unstructured":"Sood, MM, Richardson, R. Negative anion gap and elevated osmolar gap due to lithium overdose. CMAJ (Can Med Assoc J) 2007;176:921\u20133. https:\/\/doi.org\/10.1503\/cmaj.061057.","DOI":"10.1503\/cmaj.061057"},{"key":"2025121209195975713_j_jbcpp-2025-0016_ref_006","doi-asserted-by":"crossref","unstructured":"De Troyer, A, Stolarczyk, A, De Beyl, DZ, Stryckmans, P. Value of anion-gap determination in multiple myeloma. N\u00a0Engl J Med 1977;296:858\u201360. https:\/\/doi.org\/10.1056\/NEJM197704142961507.","DOI":"10.1056\/NEJM197704142961507"},{"key":"2025121209195975713_j_jbcpp-2025-0016_ref_007","doi-asserted-by":"crossref","unstructured":"Bonar, PT, Casey, JR. Plasma membrane Cl-\/HCO3- exchangers: structure, mechanism and physiology. Channels (Austin) 2008;2:337\u201345. https:\/\/doi.org\/10.4161\/chan.2.5.6899.","DOI":"10.4161\/chan.2.5.6899"},{"key":"2025121209195975713_j_jbcpp-2025-0016_ref_008","doi-asserted-by":"crossref","unstructured":"Wilkes, P. Hypoproteinemia, strong-ion difference, and acid-base status in critically ill patients. J\u00a0Appl Physiol (1985) 1998;84:1740\u20138. https:\/\/doi.org\/10.1152\/jappl.1998.84.5.1740.","DOI":"10.1152\/jappl.1998.84.5.1740"},{"key":"2025121209195975713_j_jbcpp-2025-0016_ref_009","unstructured":"Wilkes, P. Chapter 10. Normal [SID]. In: Kellum, JA, Elbers, PWG, editors. Stewart\u2019s Textbook of Acid-Base, 2nd ed. Egham, United Kingdom: Lulu Enterprises, UK Ltd; 2009:214 p."},{"key":"2025121209195975713_j_jbcpp-2025-0016_ref_010","doi-asserted-by":"crossref","unstructured":"Kim, GH. Pseudohyponatremia: does it matter in current clinical practice? Electrolyte. Blood Press 2006;4:77\u201382. https:\/\/doi.org\/10.5049\/EBP.2006.4.2.77.","DOI":"10.5049\/EBP.2006.4.2.77"},{"key":"2025121209195975713_j_jbcpp-2025-0016_ref_011","doi-asserted-by":"crossref","unstructured":"Thornton, CS, Haws, JT. Bromism in the modern day: case report and Canadian review of bromide intoxication. J\u00a0Gen Intern Med 2020;35:2459\u201361. https:\/\/doi.org\/10.1007\/s11606-020-05907-x.","DOI":"10.1007\/s11606-020-05907-x"},{"key":"2025121209195975713_j_jbcpp-2025-0016_ref_012","doi-asserted-by":"crossref","unstructured":"Kellum, JA, Bellomo, R, Kramer, DJ, Pinsky, MR. Etiology of metabolic acidosis during saline resuscitation in endotoxemia. Shock 1998;9:364\u20138. https:\/\/doi.org\/10.1097\/00024382-199805000-00009.","DOI":"10.1097\/00024382-199805000-00009"},{"key":"2025121209195975713_j_jbcpp-2025-0016_ref_013","unstructured":"Stewart, PA. Kellum, JA, Elbers, PWG, editors. Stewart\u2019s Textbook of Acid-Base, 2nd ed. Egham, United Kingdom: Lulu Enterprises, UK Ltd; 2009, vol 56:133\u201365 pp."},{"key":"2025121209195975713_j_jbcpp-2025-0016_ref_014","doi-asserted-by":"crossref","unstructured":"Antonogiannaki, EM, Mitrouska, I, Amargianitakis, V, Georgopoulos, D. Evaluation of acid-base status in patients admitted to ED-physicochemical vs traditional approaches. Am J Emerg Med 2015;33:378\u201382. https:\/\/doi.org\/10.1016\/j.ajem.2014.12.010.","DOI":"10.1016\/j.ajem.2014.12.010"},{"key":"2025121209195975713_j_jbcpp-2025-0016_ref_015","unstructured":"Morgan, TJ. Chapter 18. Unmeasured ions and the strong ion gap. In: Kellum, JA, Elbers, PWG, editors. Stewart\u2019s Textbook of Acid-Base, 2nd ed. Egham, United Kingdom: Lulu Enterprises, UK Ltd; 2009:323\u201337 pp."},{"key":"2025121209195975713_j_jbcpp-2025-0016_ref_016","doi-asserted-by":"crossref","unstructured":"Alevrakis, E, Papadakis, DD, Vagionas, D, Koutsoukou, A, Pontikis, K, Rovina, N, et al.. Strong ion gap and anion gap corrected for albumin and lactate in patients with sepsis in the intensive care unit. Int J Physiol Pathophysiol Pharmacol 2024;16:10\u201327. https:\/\/doi.org\/10.62347\/ptuu2265. www.ijppp.org\/ISSN:1944-8171\/IJPPP0152319.","DOI":"10.62347\/PTUU2265"},{"key":"2025121209195975713_j_jbcpp-2025-0016_ref_017","doi-asserted-by":"crossref","unstructured":"Rastegar, A. Use of the DeltaAG\/DeltaHCO3- ratio in the diagnosis of mixed acid-base disorders. J\u00a0Am Soc Nephrol 2007;18:2429\u201331. https:\/\/doi.org\/10.1681\/ASN.2006121408.","DOI":"10.1681\/ASN.2006121408"},{"key":"2025121209195975713_j_jbcpp-2025-0016_ref_018","doi-asserted-by":"crossref","unstructured":"Andersen, OS, Engel, K. A new acid-base nomogram. An improved method for the calculation of the relevant blood acid-base data. Scand J Clin Lab Invest 1960;12:177\u201386. https:\/\/doi.org\/10.3109\/00365516009062420.","DOI":"10.3109\/00365516009062420"},{"key":"2025121209195975713_j_jbcpp-2025-0016_ref_019","doi-asserted-by":"crossref","unstructured":"Berend, K. Diagnostic use of base excess in acid-base disorders. N\u00a0Engl J Med 2018;378:1419\u201328. https:\/\/doi.org\/10.1056\/NEJMra1711860.","DOI":"10.1056\/NEJMra1711860"},{"key":"2025121209195975713_j_jbcpp-2025-0016_ref_020","doi-asserted-by":"crossref","unstructured":"Chawla, LS, Shih, S, Davison, D, Junker, C, Seneff, MG. Anion gap, anion gap corrected for albumin, base deficit and unmeasured anions in critically ill patients: implications on the assessment of metabolic acidosis and the diagnosis of hyperlactatemia. BMC Emerg Med 2008;8:18. https:\/\/doi.org\/10.1186\/1471-227X-8-18.","DOI":"10.1186\/1471-227X-8-18"},{"key":"2025121209195975713_j_jbcpp-2025-0016_ref_021","doi-asserted-by":"crossref","unstructured":"Berkman, M, Ufberg, J, Nathanson, LA, Shapiro, NI. Anion gap as a screening tool for elevated lactate in patients with an increased risk of developing sepsis in the Emergency Department. J\u00a0Emerg Med 2009;36:391\u20134. https:\/\/doi.org\/10.1016\/j.jemermed.2007.12.020.","DOI":"10.1016\/j.jemermed.2007.12.020"},{"key":"2025121209195975713_j_jbcpp-2025-0016_ref_022","doi-asserted-by":"crossref","unstructured":"Rudkin, SE, Grogan, TR, Treger, RM. Relationship between the anion gap and serum lactate in hypovolemic shock. J\u00a0Intensive Care Med 2022;37:1563\u20138. https:\/\/doi.org\/10.1177\/08850666221106413.","DOI":"10.1177\/08850666221106413"},{"key":"2025121209195975713_j_jbcpp-2025-0016_ref_023","doi-asserted-by":"crossref","unstructured":"Forni, LG, McKinnon, W, Lord, GA, Treacher, DF, Peron, JM, Hilton, PJ. Circulating anion usually associated with the Krebs cycle in patients with metabolic acidosis. Crit Care 2005;9:R591\u20135. https:\/\/doi.org\/10.1186\/cc3806.","DOI":"10.1186\/cc3806"},{"key":"2025121209195975713_j_jbcpp-2025-0016_ref_024","doi-asserted-by":"crossref","unstructured":"Van Slyke, DD. On the measurement of buffer values and on the relationship of buffer value to the dissociation constant of the buffer and the concentration and reaction of the buffer solution. J\u00a0Biol Chem 1922;52:525\u201370. https:\/\/doi.org\/10.1016\/S0021-9258(18)85845-8.","DOI":"10.1016\/S0021-9258(18)85845-8"},{"key":"2025121209195975713_j_jbcpp-2025-0016_ref_025","doi-asserted-by":"crossref","unstructured":"Nguyen, BV, Vincent, JL, Hamm, JB, Abalain, JH, Carre, JL, Nowak, E, et al.. The reproducibility of Stewart parameters for acid-base diagnosis using two central laboratory analyzers. Anesth Analg 2009;109:1517\u201323. https:\/\/doi.org\/10.1213\/ANE.0b013e3181b62664.","DOI":"10.1213\/ANE.0b013e3181b62664"},{"key":"2025121209195975713_j_jbcpp-2025-0016_ref_026","doi-asserted-by":"crossref","unstructured":"Kellum, JA. Clinical review: reunification of acid-base physiology. Crit Care 2005;9:500\u20137. https:\/\/doi.org\/10.1186\/cc3789.","DOI":"10.1186\/cc3789"},{"key":"2025121209195975713_j_jbcpp-2025-0016_ref_027","doi-asserted-by":"crossref","unstructured":"Singer, RB, Hastings, AB. An improved clinical method for the estimation of disturbances of the acid-base balance of human blood. Med (Baltim) 1948;27:223\u201342. https:\/\/doi.org\/10.1097\/00005792-194805000-00003.","DOI":"10.1097\/00005792-194805000-00003"},{"key":"2025121209195975713_j_jbcpp-2025-0016_ref_028","doi-asserted-by":"crossref","unstructured":"Wooten, EW. Analytic calculation of physiological acid-base parameters in plasma. J\u00a0Appl Physiol (1985)1999;86:326\u201334. https:\/\/doi.org\/10.1152\/jappl.1999.86.1.326.","DOI":"10.1152\/jappl.1999.86.1.326"},{"key":"2025121209195975713_j_jbcpp-2025-0016_ref_029","unstructured":"Blood gas and pH\u00a0analysis and related measurements: approved guideline. NCCLS document no. C46. Wayne, PA: National Committee for Clinical Laboratory Standards,\u00a02001."}],"container-title":["Journal of Basic and Clinical Physiology and Pharmacology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/jbcpp-2025-0016\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/jbcpp-2025-0016\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T12:12:38Z","timestamp":1765541558000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/jbcpp-2025-0016\/html"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,1]]},"references-count":29,"journal-issue":{"issue":"2-3","published-online":{"date-parts":[[2025,3,31]]},"published-print":{"date-parts":[[2025,5,30]]}},"alternative-id":["10.1515\/jbcpp-2025-0016"],"URL":"https:\/\/doi.org\/10.1515\/jbcpp-2025-0016","relation":{},"ISSN":["2191-0286"],"issn-type":[{"type":"electronic","value":"2191-0286"}],"subject":[],"published":{"date-parts":[[2025,3,1]]}}}