Disturbances and treatment of acid-base balance.

1. Big picture

Acid-base disturbances in children are not just laboratory abnormalities. They usually mean that the child has a problem with:

Ventilation
+ circulation/perfusion
+ renal function
+ metabolism
+ gastrointestinal or renal electrolyte loss

For the exam, the safest approach is:

1. Is the child critically ill?
2. Is the pH low or high?
3. Is the primary problem respiratory or metabolic?
4. Is compensation appropriate?
5. What is the cause?
6. Treat the life-threatening problem first.

The pediatric emergency rule:

Never treat the blood gas alone. Treat the child and the cause.