Metabolic acidosis in childhood: why, when and how to treat

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dc.contributor.authorAndrade, Olberes Vitor Braga de [UNIFESP]
dc.contributor.authorIhara, Flavio de Oliveira
dc.contributor.authorTroster, Eduardo Juan
dc.contributor.institutionIrmandade Santa Casa Miserlcordia São Paulo
dc.contributor.institutionUniversidade Federal de São Paulo (UNIFESP)
dc.contributor.institutionHosp Israelita Albert Einstein
dc.contributor.institutionUniversidade de São Paulo (USP)
dc.date.accessioned2016-01-24T13:48:37Z
dc.date.available2016-01-24T13:48:37Z
dc.date.issued2007-05-01
dc.description.abstractObjectives: To critically discuss the treatment of metabolic acidosis and the main mechanisms of disease associated with this disorder; and to describe controversial aspects related to the risks and benefits of using sodium bicarbonate and other therapies.Sources: Review of PubMed/MEDLINE, LILACS and Cochrane Library databases for articles published between 1996 and 2006 using the following keywords: metabolic acidosis, lactic acidosis, ketoacidosis, diabetic ketoacidosis, cardiopulmonary resuscitation, sodium bicarbonate, treatment. Classical publications concerning the topic were also reviewed. the most recent and representative were selected, with emphasis on consensus statements and guidelines.Summary of the findings: There is no evidence of benefits resulting from the use of sodium bicarbonate for the hemodynamic status, clinical outcome, morbidity and mortality in high anion gap metabolic acidosis associated with lactic acidosis, diabetic ketoacidosis and cardiopulmonary resuscitation. Therefore, the routine use of sodium bicarbonate is not indicated. Potential side effects must be taken into consideration. Treating the underlying disease is essential to reverse the process. the efficacy of other alternative therapies has not been demonstrated in large-scale studies.Conclusions: Despite the known effects of acidemia on the organism in critical situations, a protective role of acidemia in hypoxic cells and the risk of alkalemia secondary to drug interventions are being considered. There is consensus regarding the advantages of alkali and sodium bicarbonate therapy in cases with normal anion gap; however, in the presence of high anion gap acidosis, especially lactic acidosis, diabetic acidosis and cardiopulmonary resuscitation, the use of sodium bicarbonate is not beneficial and has potential adverse effects, limiting its indication. the only points of agreement in the literature refer to the early treatment of the underlying disease and the mechanisms generating metabolic acidemia. Other promising treatment alternatives have been proposed; however, the side effects and absence of controlled studies with pediatric populations translate into lack of evidence to support the routine use of such treatments.en
dc.description.affiliationIrmandade Santa Casa Miserlcordia São Paulo, Fac Ciencias Med, São Paulo, SP, Brazil
dc.description.affiliationUniversidade Federal de São Paulo, São Paulo, SP, Brazil
dc.description.affiliationHosp Israelita Albert Einstein, Ctr Terapia Intens Pediat, São Paulo, SP, Brazil
dc.description.affiliationUniv São Paulo, Fac Med, Dept Pediat, São Paulo, SP, Brazil
dc.description.affiliationUniv São Paulo, Hosp Clin, Inst Crianca,CTI Pediat, Fac Med, São Paulo, SP, Brazil
dc.description.affiliationUnifespUniversidade Federal de São Paulo, EPM, São Paulo, SP, Brazil
dc.description.sourceWeb of Science
dc.format.extentS11-S21
dc.identifierhttp://dx.doi.org/10.2223/JPED.1616
dc.identifier.citationJornal de Pediatria. Rio de Janeiro, Rj: Soc Brasil Pediatria, v. 83, n. 2, p. S11-S21, 2007.
dc.identifier.doi10.2223/JPED.1616
dc.identifier.fileS0021-75572007000300003-en.pdf
dc.identifier.fileS0021-75572007000300003-pt.pdf
dc.identifier.issn0021-7557
dc.identifier.scieloS0021-75572007000300003
dc.identifier.urihttp://repositorio.unifesp.br/handle/11600/29685
dc.identifier.wosWOS:000254506300003
dc.language.isoeng
dc.publisherSoc Brasil Pediatria
dc.relation.ispartofJornal de Pediatria
dc.rightsinfo:eu-repo/semantics/openAccess
dc.titleMetabolic acidosis in childhood: why, when and how to treaten
dc.title.alternativeAcidose metabólica na infância: por que, quando e como tratá-la?pt
dc.typeinfo:eu-repo/semantics/article
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