Acta Scientific Paediatrics (ISSN: 2581-883X)

Review Article Volume 3 Issue 5

Acid-Base Disturbances: A Key Concept to Prevent Life-Threatening State of Sick Children

Mir Mohammad Yusuf

Assistant Professor, Critical Care Pediatric, Bangladesh Institute of Child Health (BICH), Dhaka Shishu (Children) Hospital, Bangladesh

*Corresponding Author: Mir Mohammad Yusuf, Assistant Professor, Critical Care Pediatric, Bangladesh Institute of Child Health (BICH), Dhaka Shishu (Children) Hospital, Bangladesh.

Received: February 29, 2020; Published: April 29, 2020

×

Abstract

 Essentially all sick children, can lead to acid-base disturbances. Therefore, acid-base disorders need to be anticipated in all critically ill pediatric patients. Monitoring of the acid-base status will allow the early recognition of derangements and the prevention of what could become a life-threatening state. Acidosis is the most common acid-base derangement in the pediatric intensive care unit (PICU), with metabolic acidosis pH of < 7.2 potentially indicating a more severe course and worse outcome. Further assessment of the type of acidosis and the presence of a mixed acid-base disorder requires measurement of pCO2, serum bicarbonate and calculation of the anion gap. The most commonly encountered causes of metabolic acidosis in the PICU are sepsis, renal insufficiency and DKA, while Respiratory distress syndrome (RDS), Meconium aspiration syndrome (MAS) and Severe Status Asthmaticus are the usual suspects in respiratory acidosis. Alkalosis, on the other hand, is less common in the PICU. Fluid status derangements and, especially, gastric fluid depletion are the usual underlying causes of metabolic alkalosis, whereas rapid respiration secondary to lung diseases, excessive mechanical ventilation, or central nervous system diseases are the common causes of respiratory alkalosis. In the PICU, identification of acid-base derangements is followed by timely stabilization of the patient irrespective of the underlying cause. Depending on the severity of the derangement and the patient’s response to the stabilizing interventions, the underlying cause might also need to be aggressively sought and emergently reversed. Identification of the underlying cause(s) of the acid-base disorder at hand may be the final step in the management of these patients, but plays an important role both in the prevention of worsening of the derangement and other complications as well as in the determination of the patient’s overall prognosis.

Keywords: Acid-Base Disturbances; Sick Children; Life-Threatening State

×

References

  1. E Al-Khadra. “Disorders of the Acid-Base Status”. In: Pediatric Nephrology in the ICU. Kiessling SG, Goebel J, Somers MJG, (eds). Springer-Verlag Berlin Heidelberg (2009): 19-33
  2. Rocktaeschel J., et al. “Acid-base status in critically ill patients with acute renal failure; analysis based on Stewart-Figge methodology”. Critical Care 7 (2003): 60-66.
  3. Lekhwani S., et al. “Acid-base disorders in critically ill neonates”. Indian Journal of Critical Care Medicine 14 (2010): 65-69.
  4. James LS., et al. “The acid-base status of human infants in relation to birth asphyxia and the onset of respiration”. The Journal of Pediatrics 52 (1958): 379-394.
  5. Brouillette RT and Waxman DH. “Evaluation of the newborn’s blood gas status”. American Association for Clinical Chemistry 43 (1997): 215-221.
  6. Gunnerson KJ. “Clinical review: The meaning of acid-base abnormalities in the intensive care unit Part I epidemiology”. Critical Care 9 (2005): 508-516.
  7. Orozco-Gregorio H., et al. “Importance of blood gas measurements in perinatal asphyxia and alternatives to restore the acid-base balance status to improve the newborn performance”. American Journal of Biotechnology and Biochemistry 3 (2007): 131-140.
  8. Abelow B. “Understanding Acid-base”. Williams and Wilkins 52 (1998): 210-216.
  9. Quigley R and Baum M. “Neonatal acid-base balance and disturbances”. Seminar in Perinatology 28 (2004): 97-102.
  10. Williams AJ. “Assessing and interpreting arterial blood gases and acid- base balance”. British Medical Journal 317 (1998): 1213-1216.
  11. Sekaran DV., et al. “Arterial Blood Gas Analysis in clinical practice”. Indian Paeditrics 38 (2001): 1116-1128.
  12. Kellum JA. “Clinical Review: reunification of acid-base physiology”. Critical Care 9 (2005): 500-507.
  13. Henderson LJ. “The theory of neutrality regulation in the animal organism”. American Journal Physiology 21 (1908): 427-428.
  14. Deorori AK. “Blood gas analysis”. AIIMS 3 (2008): 1-41.
  15. Cole CH., et al. “Resolving our uncertainty about oxygen therapy”. Pediatrics 112 (2003): 1415-1419.
  16. Otieno H., et al. “Are bed side features of shock reproducible between different observers?” Archives of Disease in Childhood 89 (2004): 977-999.
  17. , et al. “Brain damage from perinatal asphyxia: correlation of MR findings with gestational age”. American Journal of Neuroradiology 6 (2008): 3-27.
  18. Davis PG., et al. “Resuscitation of newborn infants with 100% oxygen or aior; a systemic review and meta-analysis”. The Lancet 364 (2004): 1329-1333.
  19. Kutzsche S., et al. “Hydrogen peroxide production in leukocytes during cerebral hypoxia and re-oxygenation with 100% or 21% oxygen in newborn”. Pediatric Research 49 (2001): 834-4247.
  20. Relman AS., et al. “What are acids and bases?” The American Journal of Medicine 4 (1954): 435-437.
  21. Lennon EJ., et al. “The effects of diet and stool composition on the net external acid balance of normal subjects”. Journal of Clinical Investigation 10 (1966): 1601-1607.
  22. West JB. “Respiratory physiology”. In: Williams and Wilkins editors”. The essentials, 7th Philadelphia: Lippincott (2005): 186.
  23. Pierce N F., et al. “The ventilatory response to acute base deficit in humans. Time course during development and correction of metabolic acidosis”. Annals of Internal Medicine 5 (1970): 633-640.
  24. Rose BD. “Clinical physiology of acid-base and electrolyte disorders”. In: McGraw-Hill 5th New York (2001): 992.
  25. DuBose TD. “Clinical approach to patients with acid-base disorders”. Medical Clinics of North America 4 (1983): 799-813.
  26. Maxwell MH., et al. “Clinical disorders of fluid and electrolyte metabolism”. In: McGraw-Hill 4th New York (1987): 1268.
  27. Chen ZL., et al. “Clinical study on improving the diagnostic criteria for neonatal asphyxia”. Zhonghua Er Ke Zazhi 44 (2006): 167-172.
  28. Palsdottir K Thorkelsson T and Dagbjartsson A. “Birth asphyxia, neonatal risk factors for hypoxic ischemic encephalopathy”. Laenabladid 93 (2007): 669-673.
  29. Ahmad I., et al. “Acid-base disorders in critically ill neonatal ICU patients and predicting survival by the presence of deranged Acid-Base variables”. Journal of Neonatal Biology 5 (2015): 207-215.
  30. Goodwin TM., et al. “Asphyxia complications in the term newborn with severe umbilical academia”. American Journal of Obstetrics and Gynecology 167 (1992):1506-1512.
  31. Lolekha PH and Lolekha S. “Value of the anion gap in clinical diagnosis and laboratory evaluation”. Clinical Chemistry2 (1983): 279-283.
  32. Bushinsky DA., et al. “Arterial pCO2 in chronic metabolic acidosis”. Kidney International 3 (1982): 311-314.
  33. Javaheri S and Kazemi H. “Metabolic alkalosis and hypoventilation in humans”. American Review of Respiratory Disease 4 (1987): 1011-1016.
  34. Javaheri S., et al. “Compensatory hypoventilation in metabolic alkalosis”. Chest3 (1982): 296-301.
  35. Polak A., et al. “Effects of chronic hypercapnia on electrolyte and acid-base equilibrium. I. Adaptation”. Journal of Clinical Investigation 40 (1961): 1223-1237.
  36. Van Y Perselle de S., et al. “The “carbon dioxide response curve” for chronic hypercapnia in man”. The New England Journal of Medicine 3 (1996): 117-122.
  37. Arbus GS., et al. “Potassium depletion and hypercapnia”. The New England Journal of Medicine 12 (1969): 670.
  38. Krapf R., et al. “Chronic respiratory alkalosis. The effect of sustained hyperventilation on renal regulation of acid-base equilibrium”. The New England Journal of Medicine 20 (1991): 1394-1401.
  39. Gennari FJ., et al. “The nature of the renal adaptation to chronic hypocapnia”. Journal of Clinical Investigation 7 (1972): 1722-1730.
  40. Adrogue HJ and Madias NE. “Management of life-threatening acid-base disorders. First of two parts”. The New England Journal of Medicine 1 (1998): 26-34.
  41. Bageant R. “Variations in arterial blood gas measurements due to sampling techniques”. Respiratory Care 20 (1975): 565.
  42. Devarajan P. “Acute Kidney injury”. In: Kliegman RM, Geme JS, Tasker RC, Wilkson KM, (eds). Nelson Textbook of Pediatrics, 21st Saunders, Philadelphia (2020): 2773.
  43. Claes DJ and Mitsnefes M. “Chronic Kidney Disease”. In: Kliegman RM, Geme JS, Tasker RC, Wilkson KM, (eds). Nelson Textbook of Pediatrics, 21st Saunders, Philadelphia (2020): 2774-2778.
  44. Gomella TL. “Abnormal blood gas”. In: Gomella TL, Cunningham MD, Eyal FG(eds). Neonatology, 7th McGraw-Hill Education, USA (2013): 325-333.
  45. Hindman BJ. “Sodium bicarbonate in the treatment of subtypes of acute lactic acidosis: physiologic considerations”. Anesthesiology 6 (1990): 1064-1076.
  46. Madias NE. “Lactic acidosis”. Kidney International 3 (1986): 752-774.
  47. Massry SG and Glassock RJ. In: Massry and Glassock’s textbook of nephrology, 4th Philadelphia: Lippincott Williams and Wilkins (2001): 2072.
  48. Fencl V., et al. “Diagnosis of metabolic Acid-Base disturbances in critically ill patients”. American Journal of Respiratory and Critical Care Medicine6 (2000): 2246-2251.
  49. Lebovitz HE. “Diabetic ketoacidosis”. Lancet 8952 (1995): 767-772.
  50. Kokko JP and Tannen RL. “Fluids and electrolytes, 3rd edition”. Philadelphia: Saunders, xii (1996): 899.
  51. Morris LR., et al. “Bicarbonate therapy in severe diabetic ketoacidosis”. Annals of Internal Medicine 6 (1986): 836-840.
  52. Okuda Y., et al. “Counterproductive effects of sodium bicarbonate in diabetic ketoacidosis”. The Journal of Clinical Endocrinology and Metabolism 1 (1996): 314-320.
  53. Glaser N., et al. “Risk factors for cerebral edema in children with diabetic ketoacidosis. The Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics”. The New England Journal of Medicine 4 (2001): 264-269.
  54. Morris LR., et al. “Bicarbonate therapy in severe diabetic ketoacidosis”. Annals of Internal Medicine6 (1986): 836-840.
  55. Cooper DJ., et al. “Bicarbonate does not improve hemodynamics in critically ill patients who have lactic acidosis. A prospective, controlled clinical study”. Annals of Internal Medicine 7 (1990): 492-498.
  56. Hindman BJ. “Sodium bicarbonate in the treatment of subtypes of acute lactic acidosis: physiologic considerations”. Anesthesiology6 (1990):1064-1076.
  57. Madias NE. “Lactic acidosis”. Kidney International 3 (1986):752-774.
  58. Massry SG and Glassock RJ. “Massry and Glassock’s textbook of nephrology, 4th edition”. Philadelphia: Lippincott Williams and Wilkins (2001): 2072.
  59. Madias NE., et al. “Severe lactic acidosis as a presenting feature of pheochromocytoma”. American Journal of Kidney Diseases 3 (1987): 250-253.
  60. Spriet LL., et al. “Effects of alkalosis on skeletal muscle metabolism and performance during exercise”. American Journal of Physiology 5-2 (1986): 833-839.
  61. Sutton JR., et al. “Effect of PH on muscle glycolysis during exercise”. Clinical Science 3 (1981): 331-338.
×

Citation

Citation: Mir Mohammad Yusuf. “Acid-Base Disturbances: A Key Concept to Prevent Life-Threatening State of Sick Children”. Acta Scientific Paediatrics 3.5 (2020): 13-23.



Indexed In




News and Events


  • Certification for Review
    Acta Scientific certifies the Editors/reviewers for their review done towards the assigned articles of the respective journals.
  • Submission Timeline for Upcoming Issue
    The last date for submission of articles for regular Issues is November 10, 2020.
  • Publication Certificate
    Authors will be issued a "Publication Certificate" as a mark of appreciation for publishing their work.
  • Best Article of the Issue
    The Editors will elect one Best Article after each issue release. The authors of this article will be provided with a certificate of “Best Article of the Issue”.
  • Welcoming Article Submission
    Acta Scientific delightfully welcomes active researchers for submission of articles towards the upcoming issue of respective journals.
  • Contact US