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VOLUME 24 , ISSUE 3 ( March, 2020 ) > List of Articles


Peritoneal Dialysis Using a Bicarbonate-buffered Dialysate in a Child with an Inborn Error of Metabolism Presenting with Severe Acidosis

Anjali Kalbhande, Uday Gajare, Preeti Shanbag

Keywords : Acute peritoneal dialysis, Bicarbonate-buffered dialysate, Inborn error of metabolism, Severe acidosis

Citation Information : 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.

DOI: 10.5005/jp-journals-10071-23372

License: CC BY-NC 4.0

Published Online: 01-03-2020

Copyright Statement:  Copyright © 2020; The Author(s).


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.

  1. Mitchell JH, Wildenthal K, Johnson RL Jr. The effects of acid-base disturbances on cardiovascular and pulmonary function. Kidney Int 1972;1(5):375–389. DOI: 10.1038/ki.1972.48.
  2. Orchard CH, Kentish JC. Effects of changes of pH on the contractile function of cardiac muscle. Am J Physiol 1990;258(6 Pt 1):C967–C981. DOI: 10.1152/ajpcell.1990.258.6.C967.
  3. Campbell GS, Houle DB, Crisp NWJr, Weil MH, Brown EBJr. Depressed response to intravenous sympathicomimetic agents in humans during acidosis. Dis Chest 1958;33(1):18–22. DOI: 10.1378/chest.33.1.18.
  4. Kraut JA, Kurtz I. Use of base in the treatment of severe acidemic states. Am J Kidney Dis 2001;38(4):703–727. DOI: 10.1053/ajkd.2001.27688.
  5. Paksu MS, Kalkan G, Asilioglu N, Paksu S, Dinler G. Gluconeogenesis defect Presenting with resistant hyperglycemis and acidosis mimicking diabetic ketoacidosis. Pediatr Emerg Care 2011;27(12):1180–1181. DOI: 10.1097/PEC.0b013e31823b412d.
  6. Vaziri ND, Ness R, Wellikson L, Barton C, Greep N. Bicarbonate-buffered peritoneal dialysis an effective adjunct in the treatment of lactic acidosis. Am J Med 1979;67(3):392–396. DOI: 10.1016/0002-9343(79)90784-8.
  7. Surtees RA, Matthews EE, Leonard JV. Neurologic outcome of propionic acidemia. Pediatr Neurol 1992;8(5):333–337. DOI: 10.1016/0887-8994(92)90085-d.
  8. Msall M, Batshaw ML, Suss R, Brusilow SW, Mellits ED. Neurologic outcome in children with inborn errors of urea synthesis: outcome of ureacycle enzymopathies. N Engl J Med 1984;310(23):1500–1505. DOI: 10.1056/NEJM198406073102304.
  9. Picca S, Dionisi-Vici C, Abeni D, Pastore A, Rizzo C, Orzalesi M, et al. Extracorporeal dialysis in neonatal hyperammonemia: modalities and prognostic indicators. Pediatr Nephrol 2001;16(11):862–867. DOI: 10.1007/s004670100702.
  10. Schaefer F, Straube E, Oh J, Mehls O, Mayatepeck E. Dialysis in neonates with inborn errors of metabolism. Nephrol Dial Transplant 1999;14(4):910–918. DOI: 10.1093/ndt/14.4.910.
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