Alkali therapy versus sodium chloride supplement in low birthweight infants with incipient late metabolic acidosis

Kalhoff, Hermann; Diekmann, L; Kunz, Clemens; Stock, G. J.; Manz, Friedrich

doi:10.1111/j.1651-2227.1997.tb08840.x

Cited by 29 publications

(16 citation statements)

References 14 publications

(14 reference statements)

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“…Between 1988 and 1992, 149 episodes of incipient late metabolic acidosis defined as a urine pH 5 5.4 on 2 consecutive days were observed in 452 low-birth weight infants who were routinely screened for maximum renal acid stimulation (urine pH 5 5.4) [84,85]. The episodes usually occurred in the 2nd and 3rd weeks of life.…”

Section: Late Metabolic Acidosismentioning

confidence: 99%

Renal acid excretion in early infancy

Manz

Kalhoff

Remer

1997

Pediatric Nephrology

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In early infancy, complex disorders of acid base metabolism are more frequent than in any other age group, with a predisposition to metabolic acidosis due to an age-related low renal capacity for acid excretion and an unphysiologically high actual renal acid load in nutrition with common formulas. Recently in preterm and small-for-gestational-age infants, persistent maximum renal net acid excretion (NAE) with subnormal or normal blood acid base status, impaired weight gain, and adaptive hormonal reactions have been observed. Incipient late metabolic acidosis is one example of a mixed disorder of acid base metabolism with maximum renal NAE in early infancy. Alkali therapy is highly effective and can be realized both on an individual basis, using urine pH screening as a diagnostic criterium for maximum renal acid stimulation, or on a general preventive level using modified standard formula with a reduced actual renal NAE similar to that seen on alimentation with human milk. From an integrated point of view, the low glomerular filtration rate and renal capacity for acid excretion beyond the developmental age of more than 44 weeks, may well be interpreted as the result of a specific adaptation to breast feeding sparing energy, and thus an evolutionary advantage for the survival of mother and child.

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Section: Late Metabolic Acidosismentioning

confidence: 99%

Renal acid excretion in early infancy

Manz

Kalhoff

Remer

1997

Pediatric Nephrology

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“…Patients of protocol I with no specific therapy (subgroup A1), however, showed a tendency for a further increase in urinary nitrogen excretion, corresponding to a higher catabolic rate. Thus, growth retardation in ILMA seems to be attributed both to a reduced gain of extracellular volume [70] and diminished cellular growth as well [66].…”

Section: Presentation Of Selected Clinical and Biochemical Data In Pamentioning

confidence: 99%

“…Patients of subgroup A1 with persistent maximum renal acid stimulation with no special therapy showed impaired weight gain compared to patients of groups B and B' on alkali therapy. Supplementation with sodium chloride (subgroup C1) seemed to promote weight gain [66].…”

Section: Presentation Of Selected Clinical and Biochemical Data In Pamentioning

confidence: 99%

“…Neglecting Na-excretion in feces, apparent Na-retention (Na-intake -Na-urine) was already negative in premature infants on day 1 with ILMA due to considerably high urinary losses of Na (Table 3), probably indicating that impaired extracellular volume expansion plays an important role as a pathophysiological compensating mechanism in this early stage of retention acidosis [6,66]. Acute acid-loading, e. g., with ammonium chloride, regularly results in a negative Na-balance and an increased activity of the renin-angiotensin-aldosterone system [69].…”

Section: Presentation Of Selected Clinical and Biochemical Data In Pamentioning

confidence: 99%

“…Fig. 4 shows the experimental protocol of two prospective randomized studies [59,60,66]. Low birth-weight infants were screened twice weekly for spontaneous de- velopment of maximum renal acid stimulation (MRAS), characterized by urine-pH values below 5.4.…”

Section: Late Metabolic Acidosis (Lma)mentioning

confidence: 99%

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Nutrition, acid-base status and growth in early childhood

Kalhoff¹,

Manz

2001

European Journal of Nutrition

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Optimal growth is only possible in a well-balanced "inner milieu". Premature infants are especially vulnerable for disturbances of acid-base metabolism with a predisposition to metabolic acidosis due to a transient disproportion between age-related low renal capacity for net acid excretion (NAE) and an unphysiologically high actual renal NAE on nutrition with standard formulas. During a 50 month period, 452 low birth-weight infants were screened for spontaneous development of incipient late metabolic acidosis (ILMA), an early stage during the development of retention acidosis, characterized by maximum renal acid stimulation (MRAS, urine-pH < 5.4) on two consecutive days but still compensated systemic acid-base status. Compared with controls, patients with ILMA showed higher serum creatinine values, an increased urinary excretion of sodium, aldosterone and nitrogen, but only slightly lower blood pH (7.38 vs 7.41) and base excess (-2.8 vs. 0.2 mmol/l) with respiratory compensation (PCO2 35 vs 37 mm Hg). Patients with altogether 149 episodes of ILMA were subsequently randomly allocated to either treatment with NaHCO3 2 mmol/kg/d for 7 days or no special therapy in protocol I, or NaHCO3 vs NaCl each 2 mmol/kg/d for 7 days in protocol II. Patients of protocol I with persistent MRAS for 7 days showed lowest weight gain and a tendency for a further increase in urinary aldosterone and nitrogen excretion. NaCl supplementation (protocol II) seemed to promote weight gain without affecting either impaired mineralization or suboptimal nitrogen retention. Patients with alkali therapy under both protocols showed normal weight gain and normalization of hormonal stimulation, mineralization (protocol II) and nitrogen assimilation. Modification of the mineral content of a standard preterm formula decreased renal NAE to the low level seen on alimentation with human milk and reduced the incidence of ILMA in preterm and small-for-gestational-age infants to 1%. The data show that ILMA is associated with impaired growth. Activation of secondary homeostatic mechanisms (extracellular volume contraction, depletion of disposable net base pools) might be important for impaired growth. Production of new formulas for reduced renal NAE could be an effective general preventive measure to reduce the clinical importance of one component of mixed acid-base disorders in early childhood.

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Sodium Bicarbonate

2007

Neonatal Formulary

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Alkali therapy versus sodium chloride supplement in low birthweight infants with incipient late metabolic acidosis

Cited by 29 publications

References 14 publications

Renal acid excretion in early infancy

Renal acid excretion in early infancy

Nutrition, acid-base status and growth in early childhood

Sodium Bicarbonate

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