Fluid, Electrolyte and Acid-Base Disturbances

One of the main roles of the kidneys is to maintain the correct acid-base balance in the body. The correct acid-base balance is essential for everything in the body to function. When acid-base balance is too low or too high, the chemical reactions that maintain the health of the body cannot occur, and molecules like proteins cannot maintain their shape. This can cause serious illness, organ failure and even death.

Acid-base balance, or pH, is determined by the number of free hydrogen ions in the blood. When there are more hydrogen ions, the pH is low, and the body is more acidic. Fewer hydrogen ions makes the body more alkaline.

The kidney maintains the correct pH by excreting hydrogen ions in urine to remove them from the body when the pH is too low. The kidneys can also resorb bicarbonate from urine to keep it in the body, which raises pH and makes the blood more alkaline.

Damaged kidneys cannot easily maintain a balance of acids and bases in the body. This can result in acidosis, or too much acid, or alkalosis, which is too much base. These conditions must be diagnosed promptly so doctors can treat the problem before it gets worse.

Renal tubal acidosis is a disease caused by the kidneys’ inability to excrete acids from the blood into the urine, making the blood too acidic.

Symptoms of Pediatric Acid-Base and Electrolyte Disorders

Some children have few symptoms. Others demonstrate:

• Confusion
• Lethargy
• Rapid breathing (hyperventilation)
• Shock; if the body is not receiving enough blood flow, oxygen flow to organs is disrupted

Diagnosis of Pediatric Acid-Base and Electrolyte Disorders

Often, children with pediatric kidney imbalances have an underlying condition, such as diabetes, cancer, liver disease or kidney disease. Achild’s doctor may order several tests to confirm a diagnosis, such as:

• Urine pH. A urine sample is tested immediately by inserting a dipstick into the sample, which indicates the level of acid in the child’s urine.
• Serum electrolytes. This blood test measures the body’s most significant electrolytes, including sodium, potassium, chloride, and bicarbonate, which help the body maintain a healthy balance of fluids and acid levels.

Treatment of Pediatric Acid-Base and Electrolyte Disorders

Determining the treatment type for acid-base and electrolyte disorders depends on the underlying cause. Treatments may include:

• Dietary restrictions
• Controlling the child’s blood sugar levels
• Prescription medication called phosphate binders to counteract high phosphate levels in the blood

Depending on the underlying conditions, a child with a pediatric kidney imbalance may need to be treated by a multidisciplinary team that could include nephrologists, urologists, oncologists and nutritionists.