# Independent variables of pH: Ten Knights of the Hydrogen Ion Kingdom-Part I. A prospective observational study

## TL;DR

This study identifies ten independent variables that accurately predict pH changes, suggesting a new approach to acid-base evaluation.

## Contribution

The study demonstrates that ten variables, including electrolytes and strong ion gap, independently influence pH.

## Key findings

- pH increases with each unit increase in Na, K, Ca, and Mg.
- pH decreases with increases in CO2, Cl, lactate, albumin, inorganic phosphorus, and strong ion gap.
- Ten variables accurately predict pH changes, suggesting current acid-base algorithms may be unnecessary.

## Abstract

CO2, HCO3, SID, and total weak acids have been defined as pH’s independent variables. However, according to Gamble, HCO3 should be equal to the difference between the sum of cations and the sum of anions besides HCO3. Therefore, if this mathematical expression is substituted for HCO3 in the Henderson-Hasselbalch equation, all independent variables of pH can be demonstrated. Our aim is to test this theory in this study. This prospective observational study was conducted between 2019 and 2020. All admitted patients to the intensive care unit who were >18 years old were included. Demographic data, blood gas parameters, albumin, magnesium, and inorganic phosphorus levels, and outcomes were recorded twice (at admission and at the 24th hour). The multivariate linear regression model was used to determine pH’s independent variables. In the multivariate linear regression model, pH was significantly increased by each unit increase in Na, K, Ca, and Mg (mmol L-1). In contrast, pH was significantly decreased by each unit increase in CO2, Cl, lactate, albumin (g dL-1), inorganic phosphorus (mg dL-1), and the strong ion gap. Ten independent variables can accurately predict the changes in pH. For this reason, all ten independent variables should be separately evaluated when interpreting the acid-base status. With this understanding, all algorithms regarding acid-base evaluation may become unnecessary.