Acid-Base Tutorial.

For Doctors, Nursing Staff, Paramedical

Staff, & Respiratory Therapists.

Alan W. Grogono, M.D.

Prof. Emeritus, Dept. of Anesthesiology,
Tulane University School of Medicine.

Nobody cares how much you know until
they know how much you care

Often attributed to Theodore Roosevelt.

This Website mixes serious learning with a little fun. That’s enough: ‘An author who speaks about his own books is almost as bad as a mother who talks about her own children’Benjamin Disraeli. Nov 19th 1873.

The Web’s Acid Base Tutorial

This Acid Base Tutorial is based on fifty years of teaching – initially in three major medical schools in two countries and latterly online.  I am acutely aware of difficulty learning this subject; accordingly, this tutorial is aimed directly at a student’s needs. Four interactive pages cover pH, the Henderson Equation, a Sea-Level Acid-Base Diagram and A High Altitude One.  This rich variety of learning tools underlie the site’s status and position.

The website also covers the underlying Science and the many Confusing Historical Decisions whose legacy still complicates this subject. Whether a beginner, or you work in emergency care or critical care, this site will help you take care of very ill patients.

Acid-Base Origins

The devastating 1952 poliomyelitis epidemic in Copenhagen demonstrated the critical need to measure PCO2 accurately. About 3,000 people were infected, of whom roughly one in ten had respiratory paralysis due to brain-stem (bulbar) poliomyelitis and about one in a hundred died. The story of how 1,500 medical and dental students provided 24-hour manual ventilation and saved about 100 lives (Berend 2018) is summarized in greater detail at the start of the History Section.

See the About the Author page for details about my creation of ventilators, design of acid-base diagrams and involvement in critical care.

The Overview of Acid-Base Balance

Respiratory: We breath to eliminate CO2.  When breathing is inadequate carbon dioxide level rises. The extra CO2 molecules combine with water to form carbonic (respiratory) acid which contributes to an acid pH. The treatment, if all else fails, is to ventilate the patient to lower the PCO2.

Metabolic: Normal metabolism produces relatively little acid but when impaired acid accumulates. For example, a poor blood supply stops oxidative metabolism and lactic acid forms. By definition, because it’s not respiratory, lactic acid is  “metabolic.” If critical the patient may require treatment using bicarbonate to neutralize this acid, possibly other intervention, and sometimes just time for excretion or metabolism.

Overview: The above eight sentences cover the whole of acid-base balance. As you explore this site, keep this overview in mind. Acute clinical problems usually result in acidosis which explains the emphasis.

Getting Started

HistoryPhysiology, Terminology, and the Sea Level Diagram are all good starting places. Or, use the Index and select a topic of interest to you.

Acknowledgements and Thanks to:

  • Tulane University School of Medicine for hosting this website until Hurricane Katrina disabled their servers.
  • Tulane’s Department of Anesthesiology for fostering my interest in creating website-based teaching materials.
  • Frank House, for painstakingly reading and correcting countless typographical, spelling, syntactic, and scientific errors.
  • Martin Grogono – for patiently introducing me to WordPress.