Persistent metabolic acidosis in ELBW

[febrea]

How do you approach the ELBW with persistent metabolic acidosis?

[manberbenitez]

1.- Check the amount of IV liquids that you are given
2.- Check the arterial pressure, and mantain in normal range for age or weight
3.- Check th renal function.
4.- If you have orally supplementation, be carefull with the protein amounts that you are given.
5.- Are you give , L cysteine, more than the regular amount in relation to protein supplementation can produce metabolic acidosis.
6.- Check symtomatic PDA.
7.- Metabolic screening.
hope this help

[JACK]

What do you mean by metabolic acidosis? Define your cut-off range?
In ELBW expect some degree of acidosis but allow a low Bicarb as long as pH is more than 7.25.
However rule out all possible causes of metabolic acidosis, ensure proper hydration, rule out sepsis and of course dont forget an Echocardiography to rule out a PDA. ( I know there is no murmur but still do a Echo.)

If all is well dont be very aggressive in bringing that bicarb to a level you think is normal. Sometimes things are best left untouched.