What is the role of metabolic acidosis in the pathophysiology of pediatric dehydration?

Updated: Nov 12, 2018
  • Author: Alex Koyfman, MD; Chief Editor: Muhammad Waseem, MBBS, MS, FAAP, FACEP, FAHA  more...
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Answer

The most common acid-base derangement that occurs with volume depletion, especially in infants, is metabolic acidosis. Mechanisms include bicarbonate loss in stool, ketone production from starvation, and lactic acid production from decreased tissue perfusion. Decreased renal perfusion also causes decreased glomerular filtration rate, which, in turn, leads to decreased hydrogen (H+) ion excretion. These factors can combine to produce a metabolic acidosis.

In most patients, acidosis is mild and easily corrected with volume restoration; increased renal perfusion permits excretion of excess H+ ions in the urine. Administration of glucose-containing fluids after initial resuscitation further decreases ketone production.


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