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Severe metabolic acidemia in infants: clinical and therapeutic aspects

W Feldman, D G Stevens, P H Beaudry

    Canadian Medical Association Journal
    |March 24, 2010
    PubMed

    Insights

    Severe metabolic acidemia in infants presents with specific clinical signs. Rapid sodium bicarbonate treatment is effective and safe, but requires monitoring for hypocalcemia.

    Area of Science:

    • Pediatrics
    • Neonatology
    • Critical Care Medicine

    Background:

    • Severe metabolic acidemia (pH < 7) in infants can present with serious clinical signs.
    • These signs may be misdiagnosed as other conditions like pneumonia or heart failure.

    Purpose of the Study:

    • To investigate the clinical manifestations of severe metabolic acidemia in infants.
    • To evaluate the efficacy and safety of sodium bicarbonate treatment.
    • To highlight the importance of accurate acid-base monitoring.

    Main Methods:

    • Study included 10 infants with severe metabolic acidemia.
    • Clinical signs were observed and correlated with acidemia.
    • Treatment involved rapid intravenous sodium bicarbonate administration.
    • Monitoring for hypocalcemia was conducted.

    Main Results:

    • Clinical signs such as hyperventilation, coma, vascular collapse, enlarged liver, and abdominal distension were linked to acidemia.
    • Five infants were initially misdiagnosed.
    • Rapid correction of acidemia with sodium bicarbonate led to dramatic clinical improvement.
    • Treatment was safe when hypocalcemia was managed.

    Conclusions:

    • Clinical signs observed in infants are directly related to severe metabolic acidemia.
    • Sodium bicarbonate is a safe and effective treatment for severe metabolic acidemia in infants when hypocalcemia is addressed.
    • Blood bicarbonate levels alone are insufficient; repeated measurements of hydrogen ion concentration, Pco(2), and bicarbonate are crucial for accurate assessment and treatment.

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