Recurrent severe metabolic acidosis in prematurely born infant – Case Report

Elitsa Valerieva, MD, Preslava Gatseva, MD, Victoria Atanasova, MD, PhD
2017 International Journal of Current Research in Medical Sciences  
Metabolic acidosis (MA) is not a disease but rather a biochemical abnormality due to disorder of the acid-alkaline homeostasis. Untreated, the severe MA is urgent condition for patients at any age and can lead to myocardial depression, convulsions, shock, and multiorgan failure. Common causes of MA in the neonates are sepsis, necrotizing enterocolitis, hypothermia, asphyxia, intracranial haemorrhages, persistent ductus arteriosus, shock, and drugs. Rare causes are inborn errors of metabolism,
more » ... rs of metabolism, renal tubular acidosis, increased loss of bicarbonates through the unstable stools due to malabsorbtion, starvation. We present a case of severe recurrent MA in a newborn of risk pregnancy (43-aged mother, in vitro conception), born prematurely with symmetric intrauterine growth restriction. The early neonatal period was compromised by necrotizing enterocolitis with small intestine perforation. Surgery intervention was performed on the 12 th postnatal day (partial small intestine resection and outputting of anus praeter iliacus). Congenital heart anomaly (atrial septal defect) as an accompanying disease was presented by cardiac failure in the first few weeks. The clinical course was aggravated additionally by toxic lever injury with cholestasis due to prolonged parenteral nutrition and difficulties in enteral nutrition. The incidents of decompensate MA came forward after 6 th postnatal (41 st postconceptual) week and high doses of bicarbonate were needed for adequate correction. These cases of MA were interpreted as result of high bicarbonate losses by diarrheic stools through the anus iliacus. The acid-alkaline balance was stabilized by administering of regular peroral intake of bicarbonate up to definitively surgery recovery of the normal bowel passage at the age of 6 months.
doi:10.22192/ijcrms.2017.03.01.003 fatcat:tcrd2jac5ncwbivlhptmt3cj7y