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

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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.

Copyright

Copyright: © 2020 Mir Mohammad Yusuf. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.