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Related Concept Videos

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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.

Indian Journal of Critical Care Medicine : Peer-Reviewed, Official Publication of Indian Society of Critical Care Medicine
|June 28, 2023
PubMed
Summary
This summary is machine-generated.

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).

Keywords:
Acute diarrheaNon-anion gap metabolic acidosisSevere dehydration

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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.