Because of the mathematical and physicochemical equations and formulae involved in its understanding, many doctors have put off this field of medicine, which, by common consent, has been considered a ‘difficult’ topic to teach and more difficult to practice at the bedside.

In actual fact, however, most of these Fluid, Electrolyte and Acid-Base problems are fairly easy to understand if one starts with some basic principles of chemistry and physiology. Correct understanding and application of these principles in practice lead to gratifying results for our patients, many of whose lives can thus be saved.

I feel that this topic by itself is quite interesting and intellectually challenging. What more can one ask in the field of study—beneficial to many and fascinating in its complexity?

Professor A Vimala is one of the brightest, conscientious and hard-working teachers and practitioners of Nephrology in our country today. Her commitment and teaching skills are truly extraordinary. It is fortunate indeed that she has chosen to write a book on this exciting topic for the benefit of all the students and teachers of medicine.

This book begins by describing the principles of Fluid and Electrolyte Physiology and goes on to discuss the various disorders encountered in practice. describes an approach to Acid-Base disorders, starting with physiological 10principles and goes on to discuss the various disorders in a simple and easy-to-understand manner. My friend and esteemed colleague Professor R Kasi Visweswaran has contributed the chapters on Potassium abnormality and Metabolic Alkalosis which bears his hallmark of erudition and clarity.

I must mention that the text is interspersed with practical, clinical examples which go a long way in making this book more interesting and lively.

A section on the interpretation of Arterial Blood Gas studies has been included so that the readers of the book can learn the logical practical approach to Acid-Base problems in actual clinical practice.

One chapter on the Stewart approach to acid-base makes the text up-to-date regarding some important new advances in this field. It is a commendable effort. Dr G Krishnakumar, a dedicated intensivist, has tried his level best to make this complex chapter simple. He also has made a succinct presentation on respiratory acidosis, alkalosis and ventilator management, which is a model of clarity.

I congratulate the author, Professor A Vimala for her praiseworthy effort in bringing a book, which should serve generations of medical students and young nephrologists. I hope it may also serve to attract more young physicians to this fascinating field of study.

This book is one of those really useful manuals which must be read, chewed, digested and assimilated, so that it can be easily and naturally applied in clinical practice to help a large number of patients.

May this book enjoy a great success that it so richly deserves!

As doctors with years of medical experience, we have been fortunate enough to have got a closer look at a variety of cases and medical scenarios. These experiences, while shaping our own perspectives and knowledge, have also enabled us to understand the different approaches taken by the medical professionals to specific case management. They have also made us wonder at better alternatives. Three specific areas that we have observed closely have been fluid therapy, electrolyte and ventilator management in intensive care. These areas, while being an important aspect in the treatment of any condition, have also been throwing some unique challenges at us. Right from the basics of fluid electrolyte abnormalities, fluid therapy, and analysis of pulmonary physiology to the analysis of respiratory acid-base, interpretation of ABG, maintenance of H⁺ ion balance and much more, there is often the need for a comprehensive approach. This book is an attempt to look at some such aforementioned situations and seeks to offer a better understanding and approach through specific case studies and examples.

We have drawn on a number of cases that we have personally come across and attended to and also on notes 12and observations gathered over the years of professional experience. We have also included details of the treatment given in each case. The idea is to offer some perspectives to young medical professionals so that they are better equipped to decide on the right approach to treatment, especially in the intensive care stage. So, we hope that postgraduate students, young medical professionals and others will benefit from our hindsight and take a judicious approach to handling intensive care patients.

I must also say that this book would have remained a mere dream had it not been for the help of a few people who ought to be mentioned here. From sowing the seeds of the idea to giving the right dose of inspiration and supporting through valuable suggestions and other help, there have been many people who were the driving force behind this book.

I express my sincere gratitude to Professor R Kasi Visweswaran and Dr G Krishnakumar for contributing important chapters to this text.

First, a big thanks to Professor K Lalitha, Consultant Gynecologist, SUT Hospital, Thiruvananthapuram, for being the motivation behind this book.

I would also like to thank Dr Godwin, Dr Murali and Dr Jigy Joseph, who were of invaluable help, without which this book would have been impossible. Also, a special thanks to all my dear students, the ones who keep my professional spirit alive. They were of great help during the course of writing this book.

An initiative of this kind needs a focused direction of energy and commitment, which is possible only with a strong family support. And I must say I have been fortunate in this regard. I would like to thank my brother and sisters, brothers-in-law, sister-in-law and my nieces and nephews—Shalini, 14Vivek, Gowri, Sharanya, Ananth and Nandini, all of whom supported me immensely as I threw myself into this book. I acknowledge my patients for whom it is a privilege to care.

My sincere appreciation also goes to Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Managing Director) and Mr Tarun Duneja (Director-Publishing) of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India for their support in this project.

Last, but not the least, I would like to thank the team at Jaypee Brothers Medical Publishers, New Delhi and at Kochi Branch for being instrumental in bringing out this book.