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. 2006 May;100(5):401-9.
doi: 10.1016/j.trstmh.2005.07.010. Epub 2005 Oct 27.

Characterisation of metabolic acidosis in Kenyan children admitted to hospital for acute non-surgical conditions

P Sasi  1 , M English, J Berkley, B Lowe, M Shebe, R Mwakesi, G Kokwaro
Affiliations

Characterisation of metabolic acidosis in Kenyan children admitted to hospital for acute non-surgical conditions

P Sasi et al. Trans R Soc Trop Med Hyg. 2006 May.

Abstract

Metabolic acidosis is associated with most severe malaria deaths in African children, and most deaths occur before maximum antimalarial action is achieved. Thus, specific acidosis treatment may reduce mortality. However, the underlying mechanisms remain poorly understood and no specific interventions have been developed. A detailed characterisation of this acidosis is critical in treatment development. We used the traditional and Stewart's approach to characterise acidosis in consecutive paediatric admissions for malaria and other acute non-surgical conditions to Kilifi District Hospital in Kenya. The overall acidosis prevalence was 21%. Gastroenteritis had the highest prevalence (61%). Both the mean albumin-corrected anion gap and the strong ion gap were high (>13 mmol/l and >0 mmol/l, respectively) in malaria, gastroenteritis, lower respiratory tract infection and malnutrition. Presence of salicylate in plasma was not associated with acidosis but was associated with signs of severe illness (odds ratio 2.11, 95% CI 1.1-4.2). In malaria, mean (95% CI) strong ion gap was 15 (14-7) mmol/l, and lactate, creatinine and inorganic phosphorous explained only approximately 40% of the variability in base excess (adjusted R2 = 0.397). Acidosis may be more common than previously recognised amongst paediatric admissions in Africa and is characterised by the presence of currently unidentified strong anions. In malaria, lactate and ketones, but not salicylate, are associated with acidosis. However, unidentified anions may be more important.

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Figures

Fig 1
Fig 1
Percentage of children with acidosis (whiskers, 95 % CI) GE Acute gastroenteritis LRTI Lower Respiratory Tract Infection PCM Severe malnutrition (Weight for Age Z score ≤ −3)
Fig 2
Fig 2
Scatter plot showing the correlation between (log) plasma 3-hydroxybutyrate and creatinine in children with malaria (r = 0.68, P = 0.001)
Fig 3
Fig 3
Scatter plot showing the correlation between (log) plasma 3-hydroxybutyrate and creatinine in children with gastroenteritis (r = 0.60, P = 0.001)
See this image and copyright information in PMC

References

    1. Agbenyega T, Planche T, et al. Population kinetics, efficacy, and safety of dichloroacetate for lactic acidosis due to severe malaria in children. J Clin Pharmacol. 2003;43(4):386–96. - PubMed
    1. Allen SJ, O'Donnell A, et al. Severe malaria in children in Papua New Guinea. Qjm. 1996;89(10):779–88. - PubMed
    1. Berkley JA, Ross A, et al. Prognostic indicators of early and late death in children admitted to district hospital in Kenya: cohort study. Bmj. 2003;326(7385):361. - PMC - PubMed
    1. Breman JG. The ears of the hippopotamus: manifestations, determinants, and estimates of the malaria burden. Am J Trop Med Hyg. 2001;64(1-2 Suppl):1–11. - PubMed
    1. Constable PD. Clinical assessment of acid-base status. Strong ion difference theory. Vet Clin North Am Food Anim Pract. 1999;15(3):447–71. - PubMed

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