Hemodynamics, fluids & transfusion
Improving interpretation of metabolic acid–base disorders by correcting pH-dependent bias in base excess partitioning
Authors' conclusion
Conventional base excess partitioning is subject to a clinically relevant pH-dependent error. A variable, pH-adjusted [Na+]-[Cl-] reference value eliminates this error and provides a more reliable assessment of metabolic acid-base disturbances, especially in patients with severe acidaemia or alkalaemia.
Study context
- Population
- ICU patients from AmsterdamUMCdb
- Participants
- 5,976 patients
- Exposure
- Conventional vs pH-corrected
- Outcome
- Agreement of unmeasured ions with strong ion gap and independent effect of pH
Methodological detailsBland-Altman analyses, pH-stratified subgroups, linear regression
- Bland-Altman analyses
- pH-stratified subgroups
- Linear regression
Main finding
As reported in the abstract
Agreement with strong ion gap
| Group | Limits of agreement | Confounding effect of pH per 0.1 pH unit |
|---|---|---|
| Conventional | −5.6 to 2.9 | 1.45 |
| pH-corrected | −4.4 to 0.4 | 0.15 |
Limits of agreement
Conventional−5.6 to 2.9
pH-corrected−4.4 to 0.4
Confounding effect of pH per 0.1 pH unit
Conventional1.45
pH-corrected0.15
Observational data: associations, not effects.
Original publication
Improving interpretation of metabolic acid–base disorders by correcting pH-dependent bias in base excess partitioning. Br J Anaesth. Published 26 February 2026. doi:10.
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