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Normal Anion Gap: A Knowledge Gap
Kambagiri Pratyusha1, Atul Jindal1
1Department of Pediatrics, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India.
Insights
Normal anion gap metabolic acidosis (NAGMA) in children with diarrhea requires attention. Fluid choice during resuscitation impacts acidemia resolution, especially in severe acute malnutrition (SAM).
Area of Science:
- Pediatric critical care medicine
- Pediatric nephrology
- Pediatric gastroenterology
Background:
- Normal anion gap metabolic acidosis (NAGMA) is frequently observed in children with acute diarrhea due to bicarbonate loss.
- The choice of fluid resuscitation may influence the resolution of acidemia and the incidence of acute kidney injury (AKI).
- Existing guidelines for rehydration therapy differ for children with severe acute malnutrition (SAM).
Purpose of the Study:
- To discuss the significance of the non-anion gap component of severe metabolic acidosis in children with acute diarrhea.
- To highlight the potential impact of resuscitation fluid choice on acidemia resolution.
- To address the need for subgroup analysis in studies involving children with SAM.
Main Methods:
- Review of existing literature on metabolic acidosis in diarrheal illness.
- Discussion of fluid resuscitation strategies and their implications.
- Emphasis on the specific considerations for managing SAM.
Main Results:
- Studies suggest hyperchloremic acidosis and AKI are more common with normal saline (NS) compared to balanced crystalloids (RL, Plasmalyte).
- The type of fluid used for resuscitation can affect the degree of acidemia resolution.
- SAM is an independent risk factor for mortality and morbidity in children.
Conclusions:
- The non-anion gap component of severe metabolic acidosis in children with diarrhea warrants greater attention.
- Further research is needed to clarify the optimal fluid resuscitation strategies, particularly in the context of SAM.
- Future studies should also investigate the long-term cognitive outcomes in these children.
Abstract:
We studied with great interest the article titled "Acute diarrhea and severe dehydration in children: Does non-anion gap component of severe metabolic acidemia need more attention?" by Takia L et al. and would express our views about the same. Normal anion gap metabolic acidosis (NAGMA) is a common entity following stool loss of bicarbonate during an acute diarrheal illness. Several studies have shown that there is a higher incidence of hyperchloremic acidosis and acute kidney injury (AKI) with normal saline (NS) when compared to balanced crystalloids like Ringer's lactate (RL) or balanced salt solutions like plasmalyte. We would like to know about the type of resuscitation fluid used in the study population as it would affect the degree of resolution of acidemia. As per the World Health Organization (WHO) guidelines, rehydration therapy for children with severe acute malnutrition (SAM) is different from other children including the fluid used for bolus, i.e., RL and oral rehydration solution (ORS), i.e., rehydration solution for malnourished (ReSoMal). We would like to know if the study population included SAM children and a subgroup analysis of the same was done as SAM is an independent risk factor for mortality and morbidity. We suggest to plan studies on cognitive outcome of these children.
How To Cite This Article:
Pratyusha K, Jindal A. Normal Anion Gap: A Knowledge Gap. Indian J Crit Care Med 2023;27(4):298.
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