Fig. 7

The effect of changing the albumin level in plasma. a Adding (or removing) the albumin together with its anti-charged cation equivalent (e.g., Na⁺) varies the the SID accordingly (bold red) and the BE and pH remain constant, which contrasts with clinical observations. b Adding (or removing) the albumin in electroneutral solution with corresponding amount of H⁺ maintains the SID unchanged (bold black), but the pH rises to alkalosis for hypoalbuminemia and falls to acidosis during hyperalbuminemia, which corresponds with Stewart’s theory of acute hypoalbuminemic alkalosis