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Slow Sodium Acetate Infusion in the Correction of Metabolic Acidosis in Premature Infants FREE

Henrik Ekblad, MD; Pentti Kero, MD; Jukka Takala, MD
[+] Author Affiliations

Reprint requests to Department of Pediatrics, University Central Hospital of Turku, SF-20520 Turku, Finland (Dr Ekblad).


Am J Dis Child. 1985;139(7):708-710. doi:10.1001/archpedi.1985.02140090070032.
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• The treatment of metabolic acidosis is one of many problems encountered in the premature infant during the first days of life. In this study, 11 infants with gestational ages of no more than 34 weeks were given sodium acetate as a continuous infusion from the first day of life. The daily sodium supply was set at 3 mEq/kg. The arterial serum pH was less than 7.30 in infants at the following ages: 1 to 3 hours, four; 24 hours, two; 48 hours, one; and 72 hours, one. The base deficit was calculated to be less than 5 in four infants at the age of 1 to 3 hours, in one infant at 24 hours, in one infant at 48 hours, and in no infants at 72 hours. The serum sodium concentrations were normal. The continuous infusion of sodium acetate seems to be suitable for the slow correction of metabolic acidosis, and the daily sodium supply of 3 mEq/kg gives a stable serum sodium concentration in the premature infant with a gestational age of no more than 34 weeks.

(AJDC 1985;139:708-710)

REFERENCES

Papile L, Burstein J, Burstein R, et al:  Relationship of intravenous sodium bicarbonate infusions and cerebral intraventricular hemorrhage . J Pediatr 1978;;93:834-836.
Dykes FD, Lazzara A, Ahmann P, et al:  Intraventricular hemorrhage: A prospective evaluation of etiopathogenesis . Pediatrics 1980;; 66:42-49.
Brown ER, Stark A, Sosenko I, et al:  Bronchopulmonary dysplasia: Possible relationship to pulmonary edema . J Pediatr 1978;;92:982-984.
Bell EF, Warburton D, Stonestreet BS, et al:  Effect of fluid administration on the development of symptomatic patent ductus arteriosus and congestive heart failure in premature infants . N Engl J Med 1980;;302:598-604.
Bell EF, Oh W:  Fluid and electrolyte balance in very low birth weight infants . Clin Perinatol 1979;;6:139-150.
Campbell AGM:  Metabolic changes in the respiratory distress syndrome . Clin Endocrinol Metabol 1976;;5:55-87.
Arant BS Jr:  Fluid therapy in the neonate: Concepts in transition . J Pediatr 1982;;101: 387-389.
Mudge GH, Manning JA, Gilman A:  Sodium acetate as a source of fixed base . Proc Soc Exp Biol Med 1949;;71:136-138.
Kveim MHR, Nesbakken R:  Acetate metabolizing capacity in man . J Oslo City Hosp 1980;;30:101-104.
Mion CM, Hegstrom RM, Boen ST, et al:  Substitution of sodium acetate for sodium bicarbonate in the bath fluid for hemodialysis . Trans Am Soc Artif Intern Organs 1964;;10:110-113.
Korvenranta HJ, Kero PO, Välimäki IAT:  Intraesophageal pressure monitoring and the severity of respiratory distress syndrome . Eur J Pediatr 1982;;138:297-300.
Brady JP, Gregory GA:  Assisted ventilation , in Klaus MH, Fanaroff AA (eds): Care of the High-Risk Neonate , ed 2. Philadelphia, WB Saunders Co, pp 205-223.
Avery ME, Hodson WA:  The first drink reconsidered . J Pediatr 1966;;68:1008-1010.
Kirkendol PL, Starrs J, Gonzales FM:  The effects of acetate, lactate, succinate and gluconate on plasma pH and electrolytes in dogs . Trans Am Soc Artif Intern Organs 1980;;26: 323-326.
Kirkendol PL, Devia CJ, Bower JD, et al:  A comparison of the cardiovascular effects of sodium acetate, sodium bicarbonate and other potential sources of fixed base in hemodialysate solutions . Trans Am Soc Artif Intern Organs 1977;;23:399-404.
Kirkendol PL, Robie NW, Gonzales FM, et al:  The cardiac and vascular effects of infused sodium acetate in dogs . Trans Am Soc Artif Intern Organs 1978;;24:714-717.
Randle PJ, England J, Denton RM:  Control of the tricarboxylic acid cycle and its interactions with glycolysis during acetate utilization in rat heart . Biochemistry 1970;;117:677-695.
Aperia A, Broberger O, Elinder G, et al:  Postnatal development of renal function in preterm and full-term infants . Acta Paediatr Scand 1981;;70:183-187.
Arant BS Jr:  Developmental patterns of renal functional maturation compared in the human neonate . J Pediatr 1978;;92:705-712.
Lorenz JM, Kleinman LI, Kotagel UR, et al:  Water balance in very low-birth-weight infants: Relationship to water and sodium intake and effect on outcome . J Pediatr 1982;;101:423-432.
Aperia A, Broberger O, Thodenium K, et al:  Renal control of sodium and fluid balance in newborn infants during intravenous maintenance therapy . Acta Paediatr Scand 1975;;64:725-731.
Engelke SC, Shah BL, Vasan U, et al:  Sodium balance in very low-birth-weight infants . J Pediatr 1978;;93:837-841.
Hammarlund K, Nilsson GE, Öberg PÅ, et al:  Transepidermal water loss in newborn infants: I. Relation to ambient humidity and site of measurement and estimation of total transepidermal water loss . Acta Paediatr Scand 1977;;66:553-562.

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References

Papile L, Burstein J, Burstein R, et al:  Relationship of intravenous sodium bicarbonate infusions and cerebral intraventricular hemorrhage . J Pediatr 1978;;93:834-836.
Dykes FD, Lazzara A, Ahmann P, et al:  Intraventricular hemorrhage: A prospective evaluation of etiopathogenesis . Pediatrics 1980;; 66:42-49.
Brown ER, Stark A, Sosenko I, et al:  Bronchopulmonary dysplasia: Possible relationship to pulmonary edema . J Pediatr 1978;;92:982-984.
Bell EF, Warburton D, Stonestreet BS, et al:  Effect of fluid administration on the development of symptomatic patent ductus arteriosus and congestive heart failure in premature infants . N Engl J Med 1980;;302:598-604.
Bell EF, Oh W:  Fluid and electrolyte balance in very low birth weight infants . Clin Perinatol 1979;;6:139-150.
Campbell AGM:  Metabolic changes in the respiratory distress syndrome . Clin Endocrinol Metabol 1976;;5:55-87.
Arant BS Jr:  Fluid therapy in the neonate: Concepts in transition . J Pediatr 1982;;101: 387-389.
Mudge GH, Manning JA, Gilman A:  Sodium acetate as a source of fixed base . Proc Soc Exp Biol Med 1949;;71:136-138.
Kveim MHR, Nesbakken R:  Acetate metabolizing capacity in man . J Oslo City Hosp 1980;;30:101-104.
Mion CM, Hegstrom RM, Boen ST, et al:  Substitution of sodium acetate for sodium bicarbonate in the bath fluid for hemodialysis . Trans Am Soc Artif Intern Organs 1964;;10:110-113.
Korvenranta HJ, Kero PO, Välimäki IAT:  Intraesophageal pressure monitoring and the severity of respiratory distress syndrome . Eur J Pediatr 1982;;138:297-300.
Brady JP, Gregory GA:  Assisted ventilation , in Klaus MH, Fanaroff AA (eds): Care of the High-Risk Neonate , ed 2. Philadelphia, WB Saunders Co, pp 205-223.
Avery ME, Hodson WA:  The first drink reconsidered . J Pediatr 1966;;68:1008-1010.
Kirkendol PL, Starrs J, Gonzales FM:  The effects of acetate, lactate, succinate and gluconate on plasma pH and electrolytes in dogs . Trans Am Soc Artif Intern Organs 1980;;26: 323-326.
Kirkendol PL, Devia CJ, Bower JD, et al:  A comparison of the cardiovascular effects of sodium acetate, sodium bicarbonate and other potential sources of fixed base in hemodialysate solutions . Trans Am Soc Artif Intern Organs 1977;;23:399-404.
Kirkendol PL, Robie NW, Gonzales FM, et al:  The cardiac and vascular effects of infused sodium acetate in dogs . Trans Am Soc Artif Intern Organs 1978;;24:714-717.
Randle PJ, England J, Denton RM:  Control of the tricarboxylic acid cycle and its interactions with glycolysis during acetate utilization in rat heart . Biochemistry 1970;;117:677-695.
Aperia A, Broberger O, Elinder G, et al:  Postnatal development of renal function in preterm and full-term infants . Acta Paediatr Scand 1981;;70:183-187.
Arant BS Jr:  Developmental patterns of renal functional maturation compared in the human neonate . J Pediatr 1978;;92:705-712.
Lorenz JM, Kleinman LI, Kotagel UR, et al:  Water balance in very low-birth-weight infants: Relationship to water and sodium intake and effect on outcome . J Pediatr 1982;;101:423-432.
Aperia A, Broberger O, Thodenium K, et al:  Renal control of sodium and fluid balance in newborn infants during intravenous maintenance therapy . Acta Paediatr Scand 1975;;64:725-731.
Engelke SC, Shah BL, Vasan U, et al:  Sodium balance in very low-birth-weight infants . J Pediatr 1978;;93:837-841.
Hammarlund K, Nilsson GE, Öberg PÅ, et al:  Transepidermal water loss in newborn infants: I. Relation to ambient humidity and site of measurement and estimation of total transepidermal water loss . Acta Paediatr Scand 1977;;66:553-562.

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