Low bi-carb level HELP

[andrewsgranny, ASN, RN]

Ya'll I really need some advice.

I have a 2 1/2 yr. old grandson. Sunday pm he was a normal 2 y/o

then he woke up monday c/o a belly ache. Then started throwing up about 2 times. He went back to sleep on the floor, but was just flacid. Ok went to the Dr. lab drawn and all was ok except his

bicarb was 15. No diarrhea. only vomited twice.

The Dr. was concerned of course because he was just lifeless and admitted him. He has had what we always called stomache virus about 7 times since birth and has been hospitalizrd for it 4 times now. So discharged him yesterday no change in bicarb.

He feels great. But I'm truely concerned. I dont know much about bicarb, only that somehow it works with the kindneys.

I dont know if the vomiting is from the acidosis or the acidosis is from the vomiting or if there is something going on with the kidneys. And of course you the Dr. says lets give it somemore time.

I really need some help here.

Please help.

[jnette, ASN, EMT-I]

Hi Andrewsgranny...

generally, the pulmonary and renal systems compensate for each other to return the body's pH to normal.

In a SINGLE acid/base disorder, the system NOT causing the problem will try to compensate by returning the ratio of bicarbonate to carbonic acid to teh normal 20:1.

The lungs compensate for metabolic disturbances by changing CO2 excretion. The kidneys compensate for respiratory disturbances by altering bicarbonate retention and H+ secretion.

What seems to be going on here is as you stated.. acute or chronic metabolic acidosis (or base bicarbonate deficit). It gets pretty deep... look up your anions and the anion gap...or I should say, your DOC should be looking these up !!! An anion gap greater than 16mEq suggests excessive accumulation of of umeasured anions. Low bicarb levels and low pH suggest metabolic acidosis... you need to know whether it is acute or chronic.

I'm concerned that the babe's doc is not investigating more thouroghly...

S/S of metabolic acidosis of course vary with the severity of the acidosis.. H/A, confusion, drowsiness, N/V, increased resp. rate and depth. cold, clammy skin, dysrythmias, shock.

CHRONIC metab.acidosis is usually seen with chronic renal failure.

The bicarb and pH decrease slowly.. and the patient is often asymptomatic until the bicarb is approx. 15 or less. But the cardinal feature of metab. acidosis is a decrease in the serum bicarb level.. often accompanied by hyperkalemia as a result of the shift of potassium out of the cells.

I work in dialysis, and we have to adjust the bicarb settings for our patients according to their lab results. What are the child's calcium levels? Are they low, too?

I would be asking a LOT of questions if I were you... refresh yourknowledge on acid/base and electrolytes, ABGs, etc. Then start asking questions and expecting some answers ! The child is exposed to a high acid concentration from SOMEWHERE which is being buffered by HCO3, causing the bicarbonate concentration to fall.

I hope you get to the bottom of this... I can only give you what little I know here... and certainly advise to go back to the docs and not settle for anything less than a thorough investigation and explanation !

Hugs to you, and please keep us posted.

[andrewsgranny, ASN, RN]

Wow, thanks for the refresher course. Your reply was even more than I could have expected.

His bicarb level is back up to normal. He is back to his old self. However, I'm afraid that he will go down again and it will all be the same.

I have some studying to do and questions to ask.

Thanks for all your help.

[NotReady4PrimeTime, RN]

There are a number of congenital metabolic disorders that feature acidosis as a symptom. I wouldn't be waiting too long to have that young man checked out in great detail, know what I mean? I hope it's something benign and easily fixed. The alternative is pretty scary. Good luck.

[GRAMBLING]

Same with my son, on laborday= dx w/ dehydration and had a chem 7 and CBC w/ results of bicarb a 16 then a 15. now 2 wk later same scenario- fatigue vomitx 2, lethargic, appears some spaced out confused demeanor and increased creatine and BUN again. This time dx with constipation and given phenergan and a sx for murlax. Scary for me when he has some jerking when sleep. I am a LVN will be RN in May of 08. I need to research this BICAR scenario. Af/u chem 7 and CBC again on 10/1 to see if changed during his good and stable appearance he is 2 1/2. I am concerned about kidney function at this point and will be aggressive with this entire process at his next appointment. Please gice me some advice. Concerned Mom