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[Disorders of acid-alkaline status and electrolyte composition in appendicitis-related peritonitis in a child]
Insights
This study investigated acid-base and electrolyte imbalances in children with appendicitis-related peritonitis. Effective treatments included targeted antibiotics, thiotriazolin, potassium chloride, and hyperbaric oxygenation, eliminating mortality.
Area of Science:
- Pediatric Surgery
- Critical Care Medicine
- Biochemistry
Background:
- Appendicular peritonitis in children often presents with significant acid-base and electrolyte disturbances.
- Understanding these physiological derangements is crucial for effective clinical management.
- Previous approaches lacked a standardized, differential correction strategy.
Observation:
- Diffuse appendicular peritonitis was associated with metabolic and respiratory alkalosis in localized cases, and metabolic acidosis in generalized cases.
- Venous blood analysis revealed specific electrolyte composition (EC) and acid-alkaline state (AAS) disorders.
- Treatment efficacy varied based on peritonitis extent and concurrent pathologies.
Findings:
- For diffuse local peritonitis, ethiotropic antibacterial therapy combined with intravenous 2.5% thiotriazolin solution proved effective.
- In extended peritonitis without concurrent pathology, potassium chloride was the preferred intervention.
- Post-laparostomy, prolonged therapy with high-concentration 2.5% thiotriazolin and hyperbaric oxygenation (for closed abdominal cavities) improved outcomes.
Implications:
- A differential, complex correction approach for AAS and EC disorders, integrated with surgical interventions, significantly improved outcomes.
- This strategy has successfully eliminated mortality associated with appendicular peritonitis over the past decade.
- The findings support the development of evidence-based guidelines for managing peritonitis-related metabolic disturbances in pediatric patients.
Abstract:
In children with diffuse appendicular peritonitis the disorders of acidic-alkaline state (AAS) and the electrolytes composition (EC) of venous blood were studied. Before the operation in patients with extended peritonitis metabolic and respiratory alkalosis dominated, with general one--metabolic acidosis. In diffuse local peritonitis the conduction of ethiotropic antibacterial therapy and intravenous infusion of 2.5% thiotriazolin solution was effective; in extended peritonitis without concurrent pathology the application of potassium chloride was the method of choice. After the laparostomy conduction with programmed sanation the prolonged therapy using 2.5% thiotriazolin solution in maximal concentration was administered, in patients with general peritonitis and closed abdominal cavity the sittings of hyperbaric oxygenation were applied. Application of proposed differential complex correction of the AAS and EC disorders in conjunction with surgical methods of treatment had permitted to avoid mortality as a complication of appendicular peritonitis in last decade.