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Pediatric Acid-base and Electrolyte Disorders

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Summary

Sometimes, the kidneys or lungs fail to work as they should and your child’s system gets out of balance. Your child’s blood needs to have the right balance of acid and basic (alkaline) compounds for all of the organs to function properly. That balance, called the acid-base balance, is controlled by the kidneys and lungs.

Expanded Overview

When the kidneys are diseased or damaged, they are less able to keep a balance of the acids and bases in the body. Too much acid in the blood is called acidosis, and too much alkaline is called alkalosis.

When the imbalance is caused by your child’s lungs, it may be called respiratory acidosis and respiratory alkalosis. When the problem occurs because of the kidneys, the imbalance usually is called metabolic acidosis and alkalosis.

Metabolic acidosis is a complication of chronic kidney disease. Metabolic acidosis can occur because too much acid is produced by the body or because the kidneys are unable to remove it from the body.

Several conditions can cause the kidney to fail in it's acid production or control. These include diabetes, cancer, liver disease, and kidney disease. When metabolic acidosis occurs in kidney patients, it may be associated with renal tubular acidosis, a disease that’s caused by the kidneys’ inability to excrete acids from blood into the urine, leaving the blood too acidic.

Symptoms

Your child’s symptoms may vary depending on the reason for the acid-base disorder. Your child may have:

  • Confusion
  • Lethargy
  • Rapid breathing or hyperventilation
  • Shock (in severe cases)

Some children have few symptoms, but your child’s doctor knows to watch or test for signs of acid-base disorders because your child has a disease or condition that can cause the disorders.

Test and Diagnosis

If your child’s kidneys or lungs fail to work as they should, your child might get an acid-base disorder. The problem is caused when your child’s kidneys or lungs are not balancing acid and bases in the body.  It’s important to find out if your child has an acid-base disorder so doctors can treat the problem before it becomes worse.

Your child’s doctor will examine your child for signs or symptoms of an acid-base disorder and review your child’s medical history. Usually, doctors recognize the conditions and diseases that can lead to disorders, such as diabetes. The doctor may order tests to confirm the diagnosis, including:

  • Urine pH - Your child will be asked to provide a urine sample. Unlike other urine tests that may be sent to a laboratory, this sample is tested immediately. The healthcare provider will insert a dipstick into the urine. Color changes in the dipstick indicate the level of acid in your child’s urine.
  • Arterial blood gas test - This measures the amount of acidity, oxygen, and carbon dioxide in the blood. It tells the doctor how well your child’s lungs filter carbon dioxide from the blood and how well they transport oxygen into the blood. While most blood tests use a sample of blood from a vein, an arterial blood gas test uses blood from an artery.
  • Serum electrolytes -This blood test measures the blood levels of the body’s most significant electrolytes. These electrically charged minerals, which include sodium, potassium, chloride, and bicarbonate (carbon dioxide), help the body maintain a healthy balance of fluids and regulate the body’s acid levels.

Your doctor may order additional tests during treatment to monitor how your child is doing. Patients with many types of acid-base disorders are referred to nephrologists, doctors who specialize in treating diseases of the kidneys.

Treatment

Your child’s blood needs to have the right balance of acid and basic (alkaline) compounds for all of the organs to function properly. When that balance, called the acid-base balance, is changed because of a problem with your child’s kidneys or lungs, your child may have an acid-base disorder.

It’s important that your child receive prompt treatment for acid-base disorders such as metabolic acidosis, because symptoms of the disease can worsen if they aren’t addressed.

Your doctor will manage your child’s acid-base disorder by first treating the problem that’s causing it. For example, if your child has hypoglycemia, or low blood sugar, controlling blood sugar levels can help restore your child’s acid-base balance.

Among the treatments for metabolic acidosis, a common acid-base disorder related to kidney function, are:

  • Dietary restrictions - Because metabolic acid may come from dietary protein, your child’s doctor may suggest that you limit how much protein your child eats.
  • If your child has an acid-base disorder caused by the lungs and breathing, your child’s doctor might recommend supplemental sodium bicarbonate, either in pill (bicarbonate) or liquid (sodium citrate) form to improve the level of carbon dioxide in your child’s blood.
  • Your child also might receive a type of medication called phosphate binders, which are used to counteract high levels of phosphate in the blood.

Resources

FAQs

What does acid-base mean?

In order for the body to function properly, the blood needs to have an appropriate balance of acid and basic (alkaline) compounds. That balance, called the acid-base balance, is controlled by the lungs and the kidneys.

What are acid-base disorders?

An acid-base disorder is an abnormality in the balance of acids and bases in the body. If there’s too much acidity in the blood, the imbalance is called acidosis. If the blood is too alkaline, the imbalance is called alkalosis.

What is metabolic acidosis?

Metabolic acidosis is a complication of chronic kidney disease. Metabolic acidosis can occur because too much acid is produced by the body or because the kidneys are unable to remove acid from the body.

What causes metabolic acidosis?

Metabolic acidosis is caused by a range of conditions, including diabetes, cancer, liver disease, and kidney disease. When metabolic acidosis occurs in kidney patients, it may be associated with renal tubular acidosis, a disease that’s caused by the kidneys’ inability to excrete acids from blood into the urine, leaving the blood too acidic.

What symptoms should I be alert to in case my child has metabolic acidosis?

Symptoms may include rapid breathing or hyperventilation, confusion, lethargy, and, in severe cases, shock.

Are acid-base disorders serious?

Metabolic acidosis can be mild or severe. In severe cases it can cause shock and may be life threatening. In mild cases, it is easily treated.

How will I know if my child has an acid-base disorder?

Your child’s doctor will order blood and urine tests. Additional tests may be needed to determine the cause of the imbalance.

How are acid-base disorders treated?

Your child’s doctor may recommend dietary restrictions and mineral supplementation.

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