Stewart's approach to analysis of acid-base disorders

For most people, an indepth discussion of Stewart's method by its effects resembles an encounter with Cthulhu on a lost island in the Pacific. Since the publication of his scandalous manuscript in 1983, Peter Stewart's method of acid-base analysis has developed a cult-like following, attracted widespread criticism from clinicians, and driven countless critical care trainees to gibbering madness, with polynomial equations smeared in blood on the padding of their cells.

Asked to review Stewart's book in 2009, Neil Soni (one of the editors of Oh's Manual) remarked:

"I, like many, observed the appearance of the Stewart approach with curiosity, rapidly supplanted by apprehension as it became popular, and with anxiety when it became clear that one might be expected to explain or teach it to others."

Forget about the others. This summary chapter (Stewart's physicochemical approach to blood gas interpretation) represents an effort by the author to explain or teach it to himself, so as to stand half a chance of answering the SAQs on this topic.



Soni, N. "Stewart's Textbook of Acid–Base." British journal of anaesthesia103.1 (2009): 140-141.

Venkatesh, Bala. "Stewart's Textbook of Acid-Base." Critical Care 13.3 (2009): 306.

Seifter, Julian L. "Integration of Acid–Base and Electrolyte Disorders." New England Journal of Medicine 371.19 (2014): 1821-1831.