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Peritoneal Dialysis Using a Bicarbonate-buffered Dialysate in a Child with an Inborn Error of Metabolism Presenting
Anjali Kalbhande1, Uday Gajare1, Preeti Shanbag1
1Department of Pediatrics, ESI-Postgraduate Institute of Medical Science and Research, Model Hospital, Mumbai, Maharashtra, India.
Insights
Peritoneal dialysis with bicarbonate-buffered dialysate effectively treated severe lactic acidosis in a pediatric patient with an inborn error of metabolism. This method offers a safe alternative to traditional bicarbonate infusions in the pediatric intensive care unit.
Area of Science:
- Pediatric Critical Care Medicine
- Metabolic Disorders
- Renal Replacement Therapy
Background:
- Metabolic acidosis is common in the pediatric intensive care unit (PICU), associated with conditions like sepsis, intoxications, and inborn errors of metabolism (IEM).
- Persistent acidosis impairs cardiac function and catecholamine responsiveness.
- Conventional treatment with intravenous sodium bicarbonate can lead to hazardous complications such as hypernatremia and hypervolemia.
Abstract:
Metabolic acidosis is observed in the pediatric intensive care unit (PICU) in several conditions including sepsis, intoxications, and severe catabolic states. It is occasionally seen due to acute decompensation in an inborn error of metabolism (IEM). Persistent acidosis results in a decrease in myocardial contractility, cardiac output, and catecholamine responsiveness. The mainstay of treatment of metabolic acidosis has been intravenous sodium bicarbonate infusion. However, the large amounts of sodium bicarbonate sometimes required can be hazardous resulting in hypernatremia, hypervolemia, and hyperosmolality. We report a 3-year child who presented with persistent lactic acidosis due to an IEM whom we treated with peritoneal dialysis (PD) using a bicarbonate-buffered dialysate. The child recovered uneventfully within 72 hours of dialysis. Peritoneal dialysis using a bicarbonate-buffered dialysate is a safe and simple method of treating persistent severe acidosis in the PICU. How to cite this article: Kalbhande A, Gajare U, Shanbag P. Peritoneal Dialysis Using a Bicarbonate-buffered Dialysate in a Child with an Inborn Error of Metabolism Presenting with Severe Acidosis. Indian J Crit Care Med 2020;24(3):200-202.
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