Type of acidosis and clinical outcome in infantile gastroenteritis

Abstract

To explore different types of metabolic acidosis in acute gastroenteritis of infancy, and to correlate it with nutritional status and clinical outcome, we examined prospectively 27 consecutive infants admitted with moderate to severe dehydration and arterial blood pH less than or equal to 7.20. Serum anion gap, creatinine, divalent cations (Ca, Mg), and the anionic contribution of total protein, lactate, and phosphate as well as ketones and urine pH, were determined on admission and compared with age-matched controls. Twenty infants (Group A) presented with normal anion gap (13.1 +/- 2.7) associated with hyperchloremia (115.8 +/- 4.2 mmol/L, p less than 0.01) and diminished bicarbonate (9.7 +/- 2.4 mmol/L, p less than 0.01), compared with controls. The other seven infants (group B) demonstrated an increased anion gap (26.7 +/- 3.2, p less than 0.01), associated with significant elevations of lactate (3.4 +/- 0.7 mmol/L, p less than 0.001), total protein (93.4 +/- 12.3 g/L, p less than 0.01), as well as phosphate (2.3 +/- 0.2 mmol/L, p less than 0.01) and creatinine (164.9 +/- 45.1 mumol/L, p less than 0.001), compared with controls. No significant deviations of blood divalent cations or ketones were noted in both groups. Urine pH was less than or equal to 5.5 in all subjects. Analysis of nutritional status and clinical outcome in both groups revealed significant differences.(ABSTRACT TRUNCATED AT 250 WORDS)