It is was disappointing to read the recent review in Intensive Care Medicine on buffering in metabolic acidosis. I consider this a “pre-Copernican” approach to acid–base that does not respect basic physical–chemical principles.

The absurdity in the traditional approach is seen by the bar for buffers in mmol/L next to a bar for H+ in nmol/L, a 106 or million-fold difference! As well described by the late Peter Stewart, change in H+ ion, that is pH, is predominantly determined by the charge difference of strong ions (SID), which are essentially ions fully dissociated in water.

This charge difference creates a strong electrical force that alters the equilibrium reactions of weak acids or bases in the solution including CO2/carbonic acid (H2HCO3), albumin, and even water; these are the dominant “buffers” in plasma.

Read More