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Type of acidosis and clinical outcome in infantile gastroenteritis
Z Weizman1, S Houri, D Ben-Ezer Gradus
1Pediatric Gastroenterology and Nutrition Unit, Soroka Medical Center, Beer-Sheva, Israel.
Insights
Infants with acute gastroenteritis can develop metabolic acidosis. This study identified two types: normal anion gap metabolic acidosis and increased anion gap metabolic acidosis, correlating with different clinical outcomes.
Area of Science:
- Pediatric Nephrology
- Pediatric Gastroenterology
- Clinical Chemistry
Background:
- Acute gastroenteritis in infants frequently leads to dehydration and metabolic acidosis.
- Understanding the specific types of metabolic acidosis is crucial for predicting clinical outcomes.
Purpose of the Study:
- To differentiate types of metabolic acidosis in infants with acute gastroenteritis.
- To correlate these acidosis types with nutritional status and clinical outcomes.
Main Methods:
- Prospective examination of 27 infants with moderate to severe dehydration and arterial blood pH ≤ 7.20.
- Analysis of serum anion gap, creatinine, electrolytes, lactate, total protein, phosphate, ketones, and urine pH.
- Comparison with age-matched controls.
Main Results:
- Twenty infants (Group A) presented with normal anion gap metabolic acidosis (hyperchloremic, low bicarbonate).
- Seven infants (Group B) showed increased anion gap metabolic acidosis with elevated lactate, total protein, phosphate, and creatinine.
- No significant differences in divalent cations or ketones were observed.
- All infants had urine pH ≤ 5.5.
- Significant differences in nutritional status and clinical outcomes were noted between the groups.
Conclusions:
- Two distinct patterns of metabolic acidosis exist in infants with acute gastroenteritis.
- Increased anion gap metabolic acidosis is associated with poorer clinical outcomes and specific biochemical markers.
- Further research into management strategies based on acidosis type is warranted.
Abstract:
To explore different types of metabolic acidosis in acute gastroenteritis of infancy, and to correlate it with nutritional status and clinical outcome, we examined prospectively 27 consecutive infants admitted with moderate to severe dehydration and arterial blood pH less than or equal to 7.20. Serum anion gap, creatinine, divalent cations (Ca, Mg), and the anionic contribution of total protein, lactate, and phosphate as well as ketones and urine pH, were determined on admission and compared with age-matched controls. Twenty infants (Group A) presented with normal anion gap (13.1 +/- 2.7) associated with hyperchloremia (115.8 +/- 4.2 mmol/L, p less than 0.01) and diminished bicarbonate (9.7 +/- 2.4 mmol/L, p less than 0.01), compared with controls. The other seven infants (group B) demonstrated an increased anion gap (26.7 +/- 3.2, p less than 0.01), associated with significant elevations of lactate (3.4 +/- 0.7 mmol/L, p less than 0.001), total protein (93.4 +/- 12.3 g/L, p less than 0.01), as well as phosphate (2.3 +/- 0.2 mmol/L, p less than 0.01) and creatinine (164.9 +/- 45.1 mumol/L, p less than 0.001), compared with controls. No significant deviations of blood divalent cations or ketones were noted in both groups. Urine pH was less than or equal to 5.5 in all subjects. Analysis of nutritional status and clinical outcome in both groups revealed significant differences.(ABSTRACT TRUNCATED AT 250 WORDS)