What causes metabolic acidosis in a newborn?

Causes of metabolic acidosis in the neonatal period include birth asphyxia, sepsis, cold stress, dehydration, congenital heart diseases (hypoplastic left heart syndrome, coarctation), renal disorders (polycystic kidneys, renal tubular acidosis) and inborn errors of metabolism.

What is metabolic acidosis in infants?

Metabolic acidosis is an acid-base disorder characterized by a decrease in serum pH that results from either a primary decrease in plasma bicarbonate concentration ([HCO3-]) or an increase in hydrogen ion concentration ([H+]). It is not a disease but rather a biochemical abnormality.

How is metabolic acidosis treated in infants?

Tromethamine (also called THAM or tris [hydroxymethyl]-aminomethane) is a buffer that can be used to treat acidosis when concerns exist regarding carbon dioxide accumulation from the metabolism of administered sodium bicarbonate. THAM increases serum bicarbonate predictably: THAM + H2 CO3 → THAM-H + HCO.

What causes normal gap metabolic acidosis?

Normal anion gap acidosis (low serum HCO3 but normal anion gap) is caused by excess bicarbonate loss from either the gut (diarrhea) or kidney (renal tubular acidosis). An elevated or so-called positive anion gap suggests the presence of another unmeasured anion.

When should metabolic acidosis be corrected?

Treatment of acute metabolic acidosis by alkali therapy is usually indicated to raise and maintain the plasma pH to greater than 7.20. In the following two circumstances this is particularly important. When the serum pH is below 7.20, a continued fall in the serum HCO3- level may result in a significant drop in pH.

Is metabolic acidosis fatal?

Most symptoms are caused by the underlying disease or condition that is causing the metabolic acidosis. Metabolic acidosis itself most often causes rapid breathing. Acting confused or very tired may also occur. Severe metabolic acidosis can lead to shock or death.

Is metabolic acidosis life threatening?

Although severe episodes can be life-threatening, sometimes metabolic acidosis is a mild condition. You can treat it, but how depends on what’s causing it.

What causes unexplained metabolic acidosis in infants?

Unexplained, persistent metabolic acidosis is a common feature of IEMs that present neonatally. Calculation of the anion gap can be helpful, as conditions that cause acidosis with a normal anion gap are limited to those associated with renal and intestinal bicarbonate loss.

How to diagnose non-anion gap metabolic acidosis?

diagnosis. 1 Patient has normal anion gap with metabolic acidosis (bicarbonate < 22 mM). 2 Patient has an anion gap metabolic acidosis, but the decrease in bicarbonate is much greater than the elevation in anion gap (indicating the

What is the Nagma threshold for metabolic acidosis?

The bicarbonate is below ~ 16-18 mEq/L. Threshold for treatment may be lower for patients at increased risk of harm from metabolic acidosis (e.g. acute kidney injury or resolving diabetic ketoacidosis). NAGMA fundamentally represents an imbalance between sodium chloride and sodium bicarbonate.

What is the average pH of a newborn?

Presence or absence of an anion gap (AG) can help to distinguish the underlying etiology. In general, with a pure or uncompensated metabolic acidosis, every 10 mEq/L fall in bicarbonate (HCO 3) results in an average pH fall of 0.15. Neonates have an average arterial pH of 7.37 (range of 7.35–7.45).