Ad hominem attacks is a sign of ..you know what....
Sounds like you have a few gray hairs and dentures, so you should know better. Shame, shame.
The current critical care, anesthesiology, surgical literature is chock full of current papers on various etiologies of "acute" metabolic acidoses and how they are all detrimental on a cellular, immunologic, organ, and overall clinical level.
Granted, Stewart is cumbersome, I won't argue that, actually if you just calculate an anion gap corrected for albumin you'll get clinically close enough to the SIG that it is useful. If you calculate the SID, you'll identify hyperchloremia in less than 2 seconds, without it, many docs still just look at the absolute chloride level and if it is not "in the red" they think everything is okay.
In critically ill patients when lactate acidosis was suspected (i.e. ongoing resuscitation), metabolic acidosis in general was associated with about a 45% mortality when compared to those that don't have it. Lactate was associated with about a 56% mortality, SIG about 40% and chloride around 30% where no metabolic acidosis was associated with about 25% mortality.
Several papers highlight associations between the immune response, coagulation abnormalities, renal perfusion, post-operative N/V, etc... to hyperchloremia.
Please show me where I said Stewart's approach was new. I'd like to see that. I never stated it was new.
Not impressed with the example your setting.
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