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Acid-Base Disorders in the PICU

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Pediatric Critical Care Medicine

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Abstract

An appropriate acid-base milieu is essential for normal cellular function of the human organism. Disturbances of the pH balance frequently occur in critically ill or injured children. These pertubations most often serve as a marker of an underlying disorder responsible for their occurrence, but acid-base disturbances may in themselves require monitoring and treatment in the PICU. Proper assessment and treatment of acid-base imbalances therefore requires an understanding of terminology and measurement, insight into buffer systems, and recognition of the compensatory interactions involved in maintaining a homeostatic balance. The terms acidosis and alkalosis refer to the mechanisms which result in a given acid-base disturbance. Primary acid-base disorders are further classified as either metabolic or respiratory. Metabolic contribution to acid-base homeostasis is based on the presence of strong anions and cations. Ion strength is based on the tendency of an ion to dissociate in aqueous solutions and tendency to combine with other ions. The concentration difference between the sum of all strong anions and strong cations is defined as the strong ion difference (SID). The anion gap, determined by presence or absence of unmeasured anions, helps guide understanding of the etiology of metabolic acidosis, one of the most common disturbances in the critically ill child. Hypercapnic acidosis impacts pH balance, but could have potential therapeutic effects in children with acute lung injury. Specific therapies, such as intravenous fluids and cardiopulmonary bypass, intrinsically affect acid-base balance, and their impact should be considered.

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Authors and Affiliations

  1. Pediatric Critical Care, Children’s Healthcare of Atlanta/Emory University School of Medicine, 1405 Clifton Road NE, Atlanta, GA, 30322, USA

    James D. Fortenberry MD, MCCM, FAAP

  2. Department of Pediatrics, Division of Critical Care, Emory University and Children’s Healthcare of Atlanta at Egleston, 1405 Clifton Road NE, Tower 1, 4th Floor, Atlanta, GA, 30306, USA

    Kiran Hebbar MD, FCCM, FAAP

  3. Division of Critical Care Medicine, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, Cincinnati, OH, 45229-3039, USA

    Derek S. Wheeler MD, MMM

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  1. James D. Fortenberry MD, MCCM, FAAP
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  2. Kiran Hebbar MD, FCCM, FAAP
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  3. Derek S. Wheeler MD, MMM
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Correspondence to James D. Fortenberry MD, MCCM, FAAP .

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  1. Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA

    Derek S. Wheeler

  2. Div. of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA

    Hector R. Wong

  3. MICHR, University of Michigan Medical Scho, Ann Arbor, Michigan, USA

    Thomas P. Shanley

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Fortenberry, J.D., Hebbar, K., Wheeler, D.S. (2014). Acid-Base Disorders in the PICU. In: Wheeler, D., Wong, H., Shanley, T. (eds) Pediatric Critical Care Medicine. Springer, London. https://doi.org/10.1007/978-1-4471-6416-6_14

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