Acid-Base Balance in Pediatric Congenital Heart Patients

  • Marco Ranucci


Acid-base balance in children with congenital heart disease before and after heart surgery is of paramount importance. In general, newborns have a reduced ability to cope with metabolic acidosis, especially under parenteral nutrition. Changes in arterial pCO2 and pH determine changes in pulmonary vascular resistances, which may trigger serious hemodynamic problems in the balance between systemic and pulmonary circulation and in case of critical pulmonary blood flow (cavopulmonary connection, Fontan circulation). In patients with tetralogy of Fallot, acidosis and hypercapnia are triggers of tet-spell crisis.

In addition to these peculiar factors, after heart surgery in congenital patients, the acid-base balance is a marker of the adequacy of cardiac output to sustain the metabolic needs. Metabolic acidosis and hyperlactatemia are among the most important indirect markers of a poor cardiac output. Maintenance of a normal acid-base balance guarantees against the risk of electrolyte concentration changes (viz., potassium) which may in turn lead to arrhythmic complications. This chapter offers a brief overview of the acid-base balance in the general physiologic setting and in the particular conditions involved in the intensive care management of congenital heart children.


  1. 1.
    Gilfix BM, Bique M, Magder S. A physical chemical approach to the analysis of acid-base balance in the clinical setting. J Crit Care. 1993;8:187–97.CrossRefGoogle Scholar
  2. 2.
    Gluck SL. Acid-base. Lancet. 1998;352:474–9.CrossRefGoogle Scholar
  3. 3.
    Haber RJ. A practical approach to acid-base disorders. West J Med. 1991;155:146–51.PubMedCentralPubMedGoogle Scholar
  4. 4.
    Narins RG, Emmett M. Simple and mixed acid-base disorders: a practical approach. Medicine (Baltimore). 1980;59:161–87.CrossRefGoogle Scholar
  5. 5.
    Rector FC. Sodium, bicarbonate, and chloride absorption by the proximal tubule. Am J Physiol Renal Physiol. 1983;244:F461–71.CrossRefGoogle Scholar
  6. 6.
    Nagami G. Renal ammonia production and excretion. In: Seldin DW, Giebisch G, editors. The kidney: physiology and pathophysiology. New York: Lippincott, Williams and Wilkins; 2000. p. 1995–2013.Google Scholar
  7. 7.
    Baum M, Quigley R. Postnatal renal development. In: Seldin DW, Giebisch G, editors. The kidney: physiology and pathophysiology. New York: Lippincott, Williams and Wilkins; 2000. p. 703–26.Google Scholar
  8. 8.
    Baum M, Quigley R. Maturation of proximal tubular acidification. Pediatr Nephrol. 1993;7:785–91.CrossRefGoogle Scholar
  9. 9.
    Day R, Franklin J. Renal carbonic anhydrase in premature and mature infants. Pediatrics. 1951;7:182–5.Google Scholar

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© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Marco Ranucci
    • 1
  1. 1.Cardiovascular Anesthesia and Intensive Care DepartmentIRCCS Policlinico San DonatoMilanItaly

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