Metabolic acidosis in childhood: why, when and how to treat

Metabolic acidosis in childhood: why, when and how to treat

Alternative title Acidose metabólica na infância: por que, quando e como tratá-la?
Author Andrade, Olberes Vitor Braga de Autor UNIFESP Google Scholar
Ihara, Flavio de Oliveira Google Scholar
Troster, Eduardo Juan Google Scholar
Institution Irmandade Santa Casa Miserlcordia São Paulo
Universidade Federal de São Paulo (UNIFESP)
Hosp Israelita Albert Einstein
Universidade de São Paulo (USP)
Abstract Objectives: To critically discuss the treatment of metabolic acidosis and the main mechanisms of disease associated with this disorder; and to describe controversial aspects related to the risks and benefits of using sodium bicarbonate and other therapies.Sources: Review of PubMed/MEDLINE, LILACS and Cochrane Library databases for articles published between 1996 and 2006 using the following keywords: metabolic acidosis, lactic acidosis, ketoacidosis, diabetic ketoacidosis, cardiopulmonary resuscitation, sodium bicarbonate, treatment. Classical publications concerning the topic were also reviewed. the most recent and representative were selected, with emphasis on consensus statements and guidelines.Summary of the findings: There is no evidence of benefits resulting from the use of sodium bicarbonate for the hemodynamic status, clinical outcome, morbidity and mortality in high anion gap metabolic acidosis associated with lactic acidosis, diabetic ketoacidosis and cardiopulmonary resuscitation. Therefore, the routine use of sodium bicarbonate is not indicated. Potential side effects must be taken into consideration. Treating the underlying disease is essential to reverse the process. the efficacy of other alternative therapies has not been demonstrated in large-scale studies.Conclusions: Despite the known effects of acidemia on the organism in critical situations, a protective role of acidemia in hypoxic cells and the risk of alkalemia secondary to drug interventions are being considered. There is consensus regarding the advantages of alkali and sodium bicarbonate therapy in cases with normal anion gap; however, in the presence of high anion gap acidosis, especially lactic acidosis, diabetic acidosis and cardiopulmonary resuscitation, the use of sodium bicarbonate is not beneficial and has potential adverse effects, limiting its indication. the only points of agreement in the literature refer to the early treatment of the underlying disease and the mechanisms generating metabolic acidemia. Other promising treatment alternatives have been proposed; however, the side effects and absence of controlled studies with pediatric populations translate into lack of evidence to support the routine use of such treatments.
Language English
Date 2007-05-01
Published in Jornal de Pediatria. Rio de Janeiro, Rj: Soc Brasil Pediatria, v. 83, n. 2, p. S11-S21, 2007.
ISSN 0021-7557 (Sherpa/Romeo, impact factor)
Publisher Soc Brasil Pediatria
Extent S11-S21
Access rights Open access Open Access
Type Review
Web of Science ID WOS:000254506300003
SciELO ID S0021-75572007000300003 (statistics in SciELO)

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