Abstract
Chapter 1 of this practical handbook describes the relationship between oxygen delivery, oxygen consumption, dysoxia, and various pathological conditions associated with the acid-base balance important for pediatric cardiac intensive care therapy.
Blood gas disorders occurring in pediatric intensive care medicine and their metabolic sequelae are discussed against the background of the complex interplay of oxygen binding, O2 consumption, and CO2 production and transport. Additionally, a description is given of the most accurate way possible to interpret laboratory findings in order to ultimately understand the clinical and therapeutic implications to be derived from the results.
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Of the tissue acids, usually only lactate is routinely determined quantitatively in clinical practice (ketones usually only qualitatively). Others remain unrecognized: unmeasured acids/anions. In the presence of tissue acids, a reduction in the (HCO3 −) concentration occurs initially (Fig. <InternalRef RefID="Fig15" >1.15</Internal Ref>, column e). If the acidosis persists for longer (hours to days), there is also a compensatory decrease in the [Cl–] concentration (Fig. <InternalRef RefID="Fig15" >1.15</Internal Ref>, column f) – even before iatrogenic Cl− is supplied in the form of infusion solutions. Thus, acidosis with a decrease in the [Cl–]/[Na+] ratio highly probably indicates the presence of large quantities of tissue acids. By contrast, a [Cl−]/[Na+] ratio > 0.85 excludes the presence of tissue acids as a cause of acidosis. If hyperchloremia and lactate are found, the situation is not so clear-cut. The [Cl−]/[Na+] ratio is then between 0.72 and 0.8.
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Neuhaeuser, C., Klauwer, D. (2019). O2 Supply, CO2, and Acid-Base Balance. In: Klauwer, D., Neuhaeuser, C., Thul, J., Zimmermann, R. (eds) A Practical Handbook on Pediatric Cardiac Intensive Care Therapy. Springer, Cham. https://doi.org/10.1007/978-3-319-92441-0_1
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