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Nutrition Support Blog: Acid-Base Anxiety

Posted by SF8N at Oct 14, 2014 10:12 AM |
October 14, 2014
Nutrition Support Blog: Acid-Base Anxiety

by Joe Krenitsky, MS, RD

There were some topics in school, such as statistics (OK, math of any kind) that never failed to make my head hurt and my palms sweat as I struggled to comprehend and retain what was being presented.  Other lessons were not covered in great depth and detail (no doubt to make time for critical scoop size and servings in a No. 10 can wisdom*) or seemed so abstract, that the take-home messages never really made it to my long-term memory.  The fundamentals of acid-base balance were “all of the above” for me in school  because we did not spend a great deal of time on the topic, what I learned did not seem clinically relevant, and all I remembered was vague notions of something called the Henderson-Hasselbalch equation that looked too much like math to me.  Once I started to work in nutrition support, I soon realized that my clinical knowledge of acid-base was woefully inadequate. 

I struggled to master the basics on my own, and found that once I had decent explanations, with the clinical relevance of acid-base disturbances emphasized, the fog lifted and the whole topic seemed relatively straightforward.  For those of you who have participated in our Nutrition Support Traineeship or Weekend Warrior program and attended Dr. Corbett’s lecture – you understand the difference the right instructor can make! 

There is a certain justice now that the tables are turned, and I am in a position to help teach acid-base to dietetic interns and nutrition support professionals.  Although the topic can feel daunting, I think that my efforts to learn on my own have helped me to teach others.  At the very least, my effort to educate others has enhanced my own understanding, and I stay on the lookout for good materials.  A new article in The New England Journal of Medicine on assessment of acid-base disturbances is a good review of acidosis, alkalosis, anion gap – and includes several clinical cases that illustrate how the academic information can be used.(1)  http://www.nejm.org/doi/full/10.1056/NEJMra1003327

If reading about acid-base and anion gap still makes your palms sweat or your head hurt – know that you are not alone, and although it may seem confusing at first, if you keep trying, you will be able to “get it” eventually.   Sometimes it can be all about finding the right teacher.  We have been very fortunate to work with talented professionals that have spent their career honing skills for medical education.  Once I sat there and realized that the material in front of me seemed obvious and straightforward, and then was told I was looking at the Henderson-Hasselbalch equation – I knew we had to help pass this on.  

You teach best what you most need to learn.”

-Richard Bach, Illusions

“Accept the challenges so that you can feel the exhilaration of victory.”
- General George Patton Jr

*typically, there are 26, ½ cup servings in a No. 10 can.  :)

Disclosure:  The author has no conflicts of interest related to this article, but readily admits that he did have to confirm the proper spelling of Henderson-Hasselbalch and anything related to No. 10 cans with internet searches.


1.   Berend K, de Vries AP, Gans RO.  Physiological Approach to Assessment of Acid-Base Disturbances.  N Engl J Med. 2014 Oct 9;371(15):1434-1445.

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