Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 14 , ISSUE 2 ( April, 2010 ) > List of Articles

RESEARCH ARTICLE

Acid-base disorders in critically ill neonates

S. Lekhwani, V. Shanker, G. Gathwala, N.D. Vaswani

Keywords : Blood gas analysis, metabolic acidosis, plasma lactate

Citation Information : Lekhwani S, Shanker V, Gathwala G, Vaswani N. Acid-base disorders in critically ill neonates. Indian J Crit Care Med 2010; 14 (2):65-69.

DOI: 10.4103/0972-5229.68217

License: CC BY-ND 3.0

Published Online: 01-12-2018

Copyright Statement:  Copyright © 2010; The Author(s).


Abstract

Objective: To study acid-base imbalance in common pediatric diseases (such as sepsis, bronchopneumonia, diarrhea, birth-asphyxia etc.) in neonates. Design and Setting: An observational study was conducted in an emergency room of a tertiary teaching care hospital in Haryana, India. Patients and Methods: Fifty neonates (from first hour to one month) attending pediatric emergency services with various ailments. Blood gas analysis, electrolytes, plasma lactate, and plasma albumin were estimated in neonates. Results: Metabolic acidosis was the most common acid-base disorder. Hyperlactatemia was observed in more than half of such cases. Birth asphyxia was another common disorder with the highest mortality in neonates followed by bronchopneumonia and sepsis. Significant correlation between mortality and critical values of lactate was observed. Conclusion: Birth asphyxia with high-lactate levels in neonates constituted major alterations in acid-base disorders seen in an emergency room of a tertiary teaching care hospital. Plasma lactate concentration measurement provides an invaluable tool to assess type of metabolic acidosis in addition to predicting mortality in these neonates.


PDF Share
  1. Henderson LJ. The theory of neutrality regulation in the animal organism. Am J Physiol 1908;21:427-48.
  2. Abelow B. Understanding Acid-Base. Baltimore: Williams and Wilkins; 1998. P. 52-4.
  3. Kellum JA. Clinical review: reunification of acid-base physiology. Crit Care 2005;9:500-7.
  4. Sirker AA, Rhodes A, Grounds RM, Bennett ED. Acid-base physiology: the ′traditional′ and the ′modern′ approaches. Anaesthesia 2002;57: 348-56.
  5. Corey HE. Stewart and beyond: new models of acid-base balance. Kidney Int 2003;64:777-87.
  6. Corey HE. Bench-to-bedside review: Fundamental principles of acid-base physiology. Crit Care 2005;9:184-92.
  7. Figge J, Jabor A, Kazda A, Fencl V. Anion gap and hypoalbuminemia. Crit Care Med 1998;26:1807-10.
  8. Rocktaeschel J, Morimatsu H, Uchino S, Goldsmith D, Poustie S, Story D, et al. Acid-base status of critically ill patients with acute renal failure: analysis based on Stewart-Figge methodology. Crit Care 2003;7:60-6.
  9. Otieno H, Were E, Ahmed I, Charo E, Brent A, Maitland K. Are bedside features of shock reproducible between different observers? Arch Dis Child 2004;89:977-9.
  10. Deshpande SA, Platt MP. Association between blood lactate and acid-base status and mortality in ventilated babies. Arch Dis Child Fetal Neonatal Ed 1997;76:15-20.
  11. Shimojo N, Naka K, Nakajima C, Yoshikawa C, Okuda K, Okada K. Test-strip method for measuring lactate in whole blood. Clin Chem 1989;35:1992-4.
  12. Wiese J, Didwania A, Kerzner R, Chernow B. Use of different anticoagulants in test tubes for analysis of blood lactate concentrations: Part 2. Implications for the proper handling of blood specimens obtained from critically ill patients. Crit Care Med 1997;25:1847-50.
  13. Jackson EV Jr, Wiese J, Sigal B, Miller J, Bernstein W, Kassel D, et al. Effects of crystalloid solutions on circulating lactate concentrations: Part 1. Implications for the proper handling of blood specimens obtained from critically ill patients. Crit Care Med 1997;25:1840-6.
  14. Johnson AM. Amino acids, Peptides and Proteins. In: Burtis CA, Ashwood ER, Bruns DE, editors. Tietz textbook of clinical chemistry and molecular diagnostics. 4th ed. St. Louis: Elsevier; 2006. p. 577-88.
  15. Fencl V, Jabor A, Kazda A, Figge J. Diagnosis of metabolic acid-base disturbances in critically ill patients. Am J Respir Crit Care Med 2000;162:2246-51.
  16. Neligan PJ, Deutschman CS. Peroperative acid-base balance. In: Miller R, editor. Anesthesia. 5th ed. Philadelphia: Churchill Livingstone; 2000. p. 1599-615.
  17. da Silva S, Hennebert N, Denis R, Wayenberg JL. Clinical value of a single postnatal lactate measurement after intrapartum asphyxia. Acta Paediatr 2000;89:320-3.
  18. Pαlsdσttir K, Thσrkelsson T, Hardardσttir H, Dagbjartsson A. Birth asphyxia, neonatal risk factors for hypoxic ischemic encephalopathy. Laeknabladid 2007;93:669-73.
  19. Chen ZL, He RZ, Peng Q, Guo KY, Zhang YQ, Yuan HH. Clinical study on improving the diagnostic criteria for neonatal asphyxia. Zhonghua Er Ke Za Zhi 2006;44:167-72.
  20. Agrawal S, Sachdev A, Gupta D, Chugh K. Role of lactate in critically ill children. Ind J Crit Care Med 2004;8:173-81.
  21. Wang XY, Li WQ, Lu J, Li N, Li JS. Lipopolysaccharide decreasing albumin expression in rat hepatocytes. Hepatobiliary Pancreat Dis Int 2005;4:410-5.
  22. Ruot B, Papet I, Bechereau F, Denis P, Buffiere C, Gimonet J, et al. Increased albumin plasma efflux contributes to hypoalbuminemia only during early phase of sepsis in rats. Am J Physiol Regul Integr Comp Physiol 2003;284:707-13.
  23. Moviat M, Haren FV, Hoeven HVD. Conventional or physicochemical approach in intensive care unit patients with metabolic acidosis. Crit Care 2003;7:41-5.
  24. Schόck O, Matousovic K. Relation between pH and the strong ion difference (SID) in body fluids. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2005;149:69-73.
  25. Gauthier PM, Szerlip HM. Metabolic acidosis in the intensive care unit. Crit Care Clin 2002;18:289-308.
  26. Rossing TH, Boixeda D, Maffeo N, Fencl V. Hyperventilation with hypoproteinemia. J Lab Clin Med 1988;112:253-9.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.