Henderson-Hasselbalch vs Stewart: Another Acid-Base Controversy

The Henderson-Hasselbalch approach to acid-base physiology and disorders has been the dominant approach for the last 100 years. Over the last 20 years there has been considerable interest in a different approach developed by Peter Stewart. At the center of the controversy around the Stewart approach is replacing the role of bicarbonate with the strong-ion-difference and total weak-acid concentration.The Stewart approach, however, appears to better describe the nature and complexity of the clinical acid-base disorders of the critically ill. The old and the new maybe partially reconciled by combining Stewart’s approach with base-excess. This combination appears to have considerable clinical utility.