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The albumin, the hydrogen, the carbon dioxide, and the bicarbonate: four substances and a conflict
2023; American Physiological Society; Volume: 135; Issue: 5 Linguagem: Inglês
10.1152/japplphysiol.00616.2023
ISSN8750-7587
AutoresAimée Obolari Durço, Karina Oliveira Mota, Lino Sérgio Rocha Conceição, Diego Santos Souza,
Tópico(s)Muscle metabolism and nutrition
ResumoLetter to the EditorCall for Letters–Viewpoint: Acid-base bufferingThe albumin, the hydrogen, the carbon dioxide, and the bicarbonate: four substances and a conflictAimée Obolari Durço, Karina Oliveira Mota, Lino Sergio Rocha Conceição, and Diego Santos SouzaAimée Obolari DurçoHealth Science Graduate Program, Federal University of Sergipe, Aracaju, Brazil, Karina Oliveira MotaDepartment of Physiology, Federal University of Sergipe, São Cristóvão, Brazil, Lino Sergio Rocha ConceiçãoDepartment of Physical Therapy, Federal University of Sergipe, University Hospital, Aracaju, Brazil, andDiego Santos SouzaDepartment of Physiology, Federal University of Sergipe, São Cristóvão, BrazilPublished Online:16 Nov 2023https://doi.org/10.1152/japplphysiol.00616.2023MoreSectionsPDF (157 KB)Download PDF ToolsExport citationAdd to favoritesGet permissionsTrack citations ShareShare onFacebookTwitterLinkedInWeChat to the editor: The study of acid-base buffering is important to assess physiological blood homeostasis. However, although the evaluation of buffering capacity using different quantification methods is extremely important, they do not always provide consistent insights. The βH+ tamponade index reveals a cause-effect association between the different parameters involved, allowing a comprehensive assessment of the tamponade mechanisms influenced by physiological factors. This index, derived from the interaction between the concentration of hydrogen ions ([H+]) and the pressure of carbon dioxide (Pco2), appears as a reliable indicator of acid-base balance.The detailed analysis described in the Viewpoint by Wolf (1), based on the work of Giosa et al. (2) and Wolf (3), highlights the role of albumin and its concentration in influencing acid-base buffering, from the perspective of comparing βH+ and βVS [Stewart and Van Slyke equations (1–3)]. It supports the understanding that alterations in albumin levels can disturb the balance between the bicarbonate and carbonic acid systems and also points to the inherent correlation between pH and [HCO3−] (method of calculation of [HCO3−]) as a possible factor for which the conclusions obtained by Giosa et al. (2) and Wolf (1) (βVS and βH+) were divergent; however, it is also important to point out the inclusion of new parameters in the evaluations made by Giosa et al. (2) whenever the results seemed to corroborate with βH+. The work concludes that high levels of albumin concentration prevent acid-base buffering, affecting physical-chemical respiratory and metabolic factors, advocating, therefore, that albumin compromises buffering—just as the authors of this point of view are inclined (4).An important point of this study is the demonstration of mathematical models with a physical-chemical basis, such as electroneutrality. This approach has experimental validation to unravel the main mechanisms of acid-base buffering in plasma and blood. By adopting this methodology, the study excludes the problems of correlative and statistically based approaches, which can often lead to misleading conclusions.Although Wolf (3) deliberately did not address clinical implications, it is interesting to note that in clinical practice the role of albumin is not directly associated with its buffering power. Krbec et al. (5) discussed the acid-base effects of albumin. The authors suggested that the influence of albumin on acid-base status is due to: 1) an increase in tissue preload and prefusion (fluid management); 2) changes in the strong ion difference (SID) by infusion of albumin solvents (such as sodium octanoate and N-acetyl-tryptophan); and 3) increased plasma albumin concentration, which leads to a reduced ability plasma buffer (5). Furthermore, most albumin use in critical care is restricted to specific settings (sepsis/septic shock, liver disorders, cardiac surgery).In short, Wolf's work answers the biggest question, whether albumin reduces or increases blood's β, in an impartial manner, demonstrating strictly, through the analysis of acid-base buffering characteristics, the consistency in the results by the βH+ buffering index.DISCLOSURESNo conflicts of interest, financial or otherwise, are declared by the authors.AUTHOR CONTRIBUTIONSA.O.D., K.O.M., L.S.R.C., and D.S.S. drafted manuscript; A.O.D., K.O.M., L.S.R.C., and D.S.S. edited and revised manuscript; A.O.D., K.O.M., L.S.R.C., and D.S.S. approved final version of manuscript.REFERENCES1. Wolf MB. Acid-base buffering whether quantified as [H+] vs. Pco2 or [H+] vs. strong ion difference is both intuitive and consistent. J Appl Physiol (1985). doi:10.1152/japplphysiol.00276.2023.Link | Google Scholar2. Giosa L, Zadek F, Langer T. The buffer power of blood: a reappraisal of its mathematical expressions with implications on the role of albumin as a buffer. J Appl Physiol (1985) 135: 196–199, 2023. doi:10.1152/japplphysiol.00083.2023.Link | ISI | Google Scholar3. Wolf MB. Physicochemical properties of abnormal blood acid-base buffering. J Appl Physiol (1985) 134: 172–180, 2023. doi:10.1152/japplphysiol.00309.2022.Link | ISI | Google Scholar4. Durço AO, Conceição LSR, Souza DS. Albumin: to be, or not to be, a buffer, that is the question. J Appl Physiol (1985) 135: 201–201, 2023. doi:10.1152/japplphysiol.00288.2023.Link | ISI | Google Scholar5. Krbec M, Koudelková K, Duška F. On acid-base effects of albumin. Curr Med Res Opin 37: 1515–1516, 2021. doi:10.1080/03007995.2021.1944074.Crossref | PubMed | ISI | Google ScholarAUTHOR NOTESCorrespondence: L. S. R. Conceição (linosergiorocha@gmail.com). Download PDF Previous Back to Top Next FiguresReferencesRelatedInformation Related ArticlesAcid-base buffering whether quantified as [H+] vs. Pco2 or [H+] vs. strong ion difference is both intuitive and consistent 16 Nov 2023Journal of Applied Physiology More from this issue > Volume 135Issue 5November 2023Pages 1180-1180 Crossmark Copyright & PermissionsCopyright © 2023 the American Physiological Society.https://doi.org/10.1152/japplphysiol.00616.2023PubMed37971235History Received 1 September 2023 Accepted 4 September 2023 Published online 16 November 2023 Published in print 1 November 2023 KeywordsalbuminbufferpH Metrics
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