Rapid correction of early metabolic acidaemia in comparison with placebo, no intervention or slow correction in LBW infants

Kecskés, Zsuzsoka; Davies, Mark

doi:10.1002/14651858.cd002976

Cited by 18 publications

(14 citation statements)

References 19 publications

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“…There is conflicting literature on the effects of infusing a buffer solution during metabolic acidosis (Kecskes and Davies 2002;Andrade et al 2007;Lim 2007;Kraut and Madias 2012). This debate is a consequence of the lack of controlled studies regarding benefits, side effects and outcome of this therapy, especially in the context of rare metabolic diseases.…”

Section: Buffer Therapy During Metabolic Acidosismentioning

confidence: 99%

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Treatment options for lactic acidosis and metabolic crisis in children with mitochondrial disease

Danhauser

Smeitink

Freisinger

et al. 2015

J of Inher Metab Disea

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The mitochondrial pyruvate oxidation route is a tightly regulated process, which is essential for aerobic cellular energy production. Disruption of this pathway may lead to severe neurometabolic disorders with onset in early childhood. A frequent finding in these patients is acute and chronic lactic acidemia, which is caused by increased conversion of pyruvate via the enzyme lactate dehydrogenase. Under stable clinical conditions, this process may remain well compensated and does not require specific therapy. However, especially in situations with altered energy demands, such as febrile infections or longer periods of fasting, children with mitochondrial disorders have a high risk of metabolic decompensation with exacerbation of hyperlactatemia and severe metabolic acidosis. Unfortunately, no controlled studies regarding therapy of this critical condition are available and clinical outcome is often unfavorable. Therefore, the aim of this review was to formulate expert-based suggestions for treatment of these patients, including dietary recommendations, buffering strategies and specific drug therapy. However, it is important to keep in mind that a specific therapy for the underlying metabolic cause in children with mitochondrial diseases is usually not available and symptomatic therapy especially of severe lactic acidosis has its ethical limitations.

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Section: Buffer Therapy During Metabolic Acidosismentioning

confidence: 99%

“…However, volume overload should be avoided. 2) To minimize the increase in the intracellular acidosis, a slow application rate is recommended (see below), although there are no studies in humans available (Kecskes and Davies 2002).…”

Section: Sodium Bicarbonate Bufferingmentioning

confidence: 99%

Treatment options for lactic acidosis and metabolic crisis in children with mitochondrial disease

Danhauser

Smeitink

Freisinger

et al. 2015

J of Inher Metab Disea

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“…There is no consensus for infusion rate of NaHCO 3 in the treatment of metabolic acidosis in preterm infants [18] . The ideal speed of infusion should result in fast recovery of metabolic acidosis without negative changes in cardiorespiratory function, cerebral hemodynamics or oxygenation.…”

Section: Sodium Bicarbonate In Preterm Infantsmentioning

confidence: 99%

Effects of Rapid versus Slow Infusion of Sodium Bicarbonate on Cerebral Hemodynamics and Oxygenation in Preterm Infants

Velden¹,

Hopman²,

Klaessens³

et al. 2006

Neonatology

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Background: Sodium bicarbonate (NaHCO₃) is often used for correction of metabolic acidosis in preterm infants. The effects of NaHCO₃ administration on cerebral hemodynamics and oxygenation are not well known. Furthermore, there is no consensus on infusion rate of NaHCO₃. Objectives: To evaluate the effects of rapid versus slow infusion of NaHCO₃on cerebral hemodynamics and oxygenation in preterm infants. Methods: Twenty-nine preterm infants with metabolic acidosis were randomized into two groups (values are mean ±SD): In group A (GA 30.5 ± 1.7 weeks, b.w. 1,254 ± 425 g) NaHCO₃ 4.2% was injected as a bolus. In group B (GA 30.3 ± 1.8 weeks, b.w. 1,179 ± 318 g) NaHCO₃ 4.2% was administered over a 30-min period. Concentration changes of oxyhemoglobin (cO₂Hb) and deoxyhemoglobin (cHHb) were assessed using near infrared spectrophotometry. Changes in HbD (= cO₂Hb – cHHb) represent changes in cerebral blood oxygenation and changes in ctHb (= cO₂Hb + cHHb) reflect changes in cerebral blood volume. Cerebral blood flow velocity was intermittently measured using Doppler ultrasound. Longitudinal data analysis was performed using linear mixed models (SAS procedure MIXED), to account for the fact that the repeated observations in each individual were correlated. Results: Administration of NaHCO₃ resulted in an increase of cerebral blood volume which was more evident if NaHCO₃was injected rapidly than when infused slowly. HbD and cerebral blood flow velocity did not show significant changes in either group. Conclusion: To minimize fluctuations in cerebral hemodynamics, slow infusion of sodium bicarbonate is preferable to rapid injection.

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“…Revisões sistemáticas não demonstraram evidências de benefício de administração de BS na redução da mortalidade e morbidade na RCP de neonatos na sala de parto ou em prematuros com ACM [63][64][65] .…”

Section: Efeitos Adversos Do Uso De Bicarbonato De Sódiounclassified

Metabolic acidosis in childhood: why, when and how to treat

Andrade¹,

Ihara

Troster

2007

J Pediatr (Rio J)

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Objectives: To critically discuss the treatment of metabolic acidosis and the main mechanisms of disease associated with this disorder; and to describe controversial aspects related to the risks and benefits of using sodium bicarbonate and other therapies. Other promising treatment alternatives have been proposed; however, the side effects and absence of controlled studies with pediatric populations translate into lack of evidence to support the routine use of such treatments.J Pediatr (Rio J). 2007;83(2 Suppl):S11-21: Acidosis/therapy, acidosis, lactic, diabetic ketoacidosis, sodium bicarbonate, child.

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Rapid correction of early metabolic acidaemia in comparison with placebo, no intervention or slow correction in LBW infants

Cited by 18 publications

References 19 publications

Treatment options for lactic acidosis and metabolic crisis in children with mitochondrial disease

Treatment options for lactic acidosis and metabolic crisis in children with mitochondrial disease

Effects of Rapid versus Slow Infusion of Sodium Bicarbonate on Cerebral Hemodynamics and Oxygenation in Preterm Infants

Metabolic acidosis in childhood: why, when and how to treat

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