THE SUBJECT of acid-base balance in the human has been a difficult subject to master for most students of medicine. Partly this has been due to a confusing array of terms, partly due to an unwarranted emphasis on the changes in the various serum electrolytes which occur as the hydrogen ion concentration of the blood changes for one reason or another. Cause and effect have not always been kept in their proper perspective. This latter problem has been recognized in recent years and numerous articles have appeared in the literature reemphasizing the centrality of the hydrogen ion or proton in acid-base balance.1,2,4-7,20 The usefulness of the Brønsted theory in understanding the basic chemical changes involved and in reducing the confusion in terminology has also been the subject of many editorials.1-4,6 However, in clinical circles this does not appear to have been fully appreciated.
In order to better