[Verse 1] Henderson-Hasselbalch, pH is the ledger Bicarbonate over carbonic acid, measured with precision Six-point-one plus the log of the ratio Respiratory shifts the CO2, kidneys hold the base slow Stewart says it differently — strong ion difference, the driver Chloride heavy, acidosis; albumin drops, alkaline survivor Both frameworks tell the truth, just different dialects spoken Anion gap: sodium minus chloride minus bicarb, never broken [Chorus] Gap, base excess, pH in range MUDPILES creeping, osmol acting strange Bicarbonate drifting, CO2 in play Stewart's strong ions won't let you look away Remember the gap, remember the base Acid-base balance is the perioperative case [Verse 2] Sixty percent of body weight is water, distributed in thirds Two-thirds intracellular, one-third outside where the action occurs Plasma's only eight percent, protected by the glycocalyx layer Starling said hydrostatic pushes out, oncotic pulls back inward But the glycocalyx is the gatekeeper — degrade it and you drown Crystalloid floods the interstitium when the scaffold is torn down Edema isn't volume, context rewrites the story Hydroxyethyl starch disrupts the coat, synthetic without glory [Chorus] Gap, base excess, pH in range MUDPILES creeping, osmol acting strange Bicarbonate drifting, CO2 in play Stewart's strong ions won't let you look away Remember the gap, remember the base Acid-base balance is the perioperative case [Verse 3] Sodium commands osmolarity, hyponatremia seizes Correct too fast, central pontine myelinolysis Hypernatremia pulls the neurons tight, free water is the answer Potassium: peaked T-waves, sine wave — cardiac disaster Calcium ionized matters most, not the total in the albumin haze Hypocalcemia after transfusion, citrate binding through the malaise Magnesium quiets the myocyte, blocks NMDA in preeclampsia Low magnesium lets potassium bleed out — repletion comes first, not later [Bridge] Base excess minus three or less, metabolic compensation pending Lactic acid, ketones, salicylate — anion gap ascending Non-gap acidosis: bicarbonate wasting, hyperchloremic terrain Alkalosis: vomiting chloride, NG suction down the drain The electrolyte cascade connects across each organ system Perioperative imbalance amplifies every surgical problem [Chorus] Gap, base excess, pH in range MUDPILES creeping, osmol acting strange Bicarbonate drifting, CO2 in play Stewart's strong ions won't let you look away Remember the gap, remember the base Acid-base balance is the perioperative case [Outro] Glycocalyx intact, compartments respected Electrolytes corrected, pH redirected From Henderson to Stewart, from sodium to mag Every number in the chart is a clinical flag
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