Book Review

Acid–Base Disorders and Their Treatment

N Engl J Med 2005; 353:2520-2521December 8, 2005

Article

Acid–Base Disorders and Their Treatment
Edited by F. John Gennari, Horacio J. Adrogué, John H. Galla, and Nicolaos E. Madias. 856 pp., illustrated. Boca Raton, Fla., Taylor & Francis, 2005. $199.95. ISBN: 0-8247-5915-X

Acid–Base Disorders and Their Treatment is the second work on this subject by Madias and Gennari after a nearly 20-year hiatus since their first book, Acid–Base (Boston: Little, Brown, 1982). These two collaborators were joined by Adrogué and Galla in editing the present book. They all have enlisted a strong group of contributors, thereby permitting the inclusion of expanded text that extends into the new science of hydrogen-ion metabolism and provides a comprehensive update on clinical disorders.

Like the first book, the present compilation is strongly focused on clinical relevance, including highly prescriptive, formula-driven treatment regimens for various acid–base disorders. Unlike the first book, this book benefits from the passage of time and scholarly investigation, which permit a detailed exploration of the cellular and subcellular transport mechanisms that underlie bedside observations. The first eight chapters (section I) deal with a wealth of recent information on the physiological chemistry of acids and bases throughout the body. Among these is a fascinating chapter on the negative effects of the change from the diet of the hunter–gatherer to the modern, grain-based, acid-loaded diet over the past 10,000 years — call it the evolution of Homo sapiens to “Homo acidophilous.” I also found the chapter on the effect of the gut on net hydrogen-ion balance enlightening, as I think most readers will, regardless of their disciplines.

In sections II through IV, the four primary acid–base disorders and their variants receive careful attention. Having a particular affection for metabolic acidosis, I was inclined to judge the passages about the other three disorders against those on this topic. All measured up as full and scholarly explorations with suitable acknowledgments of the giants in acid–base research of the past, both in the text and the references. These sections identify unresolved issues, such as whether and to what extent acid retention is involved in chronic kidney disease. The controversies are evenhandedly laid out and provide a clear starting place for future research. There are also chapters dealing with uncommon abnormalities, such as renal tubular acidosis and specific exogenous toxin-induced disorders, as well as helpful descriptions of the effects of commonly used pharmaceuticals, such as diuretics, on acid–base balance.

Special chapters focus on infants and children and on patients receiving dialysis (sections V and VI), and there are thorough discussions of the technical side of acid–base measurement and standards for acid–base normality (section VII). And, yes, there is a quiz at the end of the book, in the form of questions about 17 illustrative cases that will challenge the reader. In short, this is a comprehensive reference textbook.

With regard to structure, the authors conform reasonably well to a conventional chapter format, no doubt guided by skillful editing. Chapters begin with an introductory paragraph that details the subsequent content and may contain important definitions or identify controversies. Details of pathophysiology are followed by a final clinical section and summary. Each chapter is thus a stand-alone work on the chosen topic, replete with references. This format leads to some redundancy among the chapters, which may prove tiresome for the cover-to-cover reader but is a virtue for those reading selectively.

This is a fine work, and I am pleased to have it in my library. The huge increase in knowledge offered in this book, as compared with the book of 20 years ago, is a testament to the lively investigative climate in the area of acid–base metabolism. This book should draw both students and seasoned professionals alike, whether they are nephrologists, pulmonologists, gastroenterologists, pediatricians, or general internists. The notable acid–base investigators William B. Schwartz, Donald W. Seldin, and Arnold S. Relman should all be proud of this work, as the late physiological chemist Lawrence J. Henderson would have been.

Lee W. Henderson, M.D.
480 Clapboard Hill Rd., Guilford, CT 06437
hndrsnlee@aol.com