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Medication

Medication Summary

Specific therapies are directed at the underlying disease process that causes metabolic acidosis. However, sodium bicarbonate and tromethamine (also called THAM or tris [hydroxymethyl]-aminomethane) are used to address the acidosis itself.

Class Summary

Sodium bicarbonate is used as a gastric, systemic, and urinary alkalinizer and has been used in the treatment of acidosis resulting from metabolic and respiratory causes, including, diarrhea, kidney disturbances, and shock. Alternatively, THAM is a buffering agent that increases pH without increasing levels of PaCO₂. It may be used to correct metabolic acidosis if sodium bicarbonate is contraindicated.

Sodium bicarbonate

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Sodium bicarbonate serves as a buffering agent for metabolic acidosis when significant bicarbonate losses have occurred.

Tromethamine (THAM)

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THAM combines with hydrogen ions to form bicarbonate buffer. It is used to prevent and correct systemic acidosis. It is available as 0.3-mol/L IV solution containing 18 g (150 mEq) per 500 mL (0.3 mEq/mL).

Class Summary

Vitamins are essential to normal metabolism.

Thiamine

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Thiamine is an essential coenzyme that combines with ATP to form thiamine pyrophosphate. The dosage forms include a parenteral injection (100 mg/mL) and tablets. Thiamine administration rapidly corrects the clinical symptomatology in metabolic acidosis.

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Approach for evaluating metabolic acidosis.

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Author

Lennox H Huang, MD, FAAP Chief Medical Officer, The Hospital for Sick Children; Associate Professor of Pediatrics, University of Toronto Faculty of Medicine; Associate Clinical Professor of Pediatrics, McMaster University School of Medicine, Canada

Lennox H Huang, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics, American Association for Physician Leadership, Canadian Medical Association, Ontario Medical Association, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Margaret A Priestley, MD Professor of Clinical Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania; Senior Medical Director, Critical Care Medicine, The Children's Hospital of Philadelphia

Margaret A Priestley, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Chief Editor

Timothy E Corden, MD Associate Professor of Pediatrics, Co-Director, Policy Core, Injury Research Center, Medical College of Wisconsin; Associate Director, PICU, Children's Hospital of Wisconsin

Timothy E Corden, MD is a member of the following medical societies: American Academy of Pediatrics, Phi Beta Kappa, Society of Critical Care Medicine, Wisconsin Medical Society

Disclosure: Nothing to disclose.

Acknowledgements

G Patricia Cantwell, MD, FCCM Professor of Clinical Pediatrics, Chief, Division of Pediatric Critical Care Medicine, University of Miami, Leonard M Miller School of Medicine; Medical Director, Palliative Care Team, Director, Pediatric Critical Care Transport, Holtz Children's Hospital, Jackson Memorial Medical Center; Medical Manager, FEMA, Urban Search and Rescue, South Florida, Task Force 2; Pediatric Medical Director, Tilli Kids – Pediatric Initiative, Division of Hospice Care Southeast Florida, Inc

G Patricia Cantwell, MD, FCCM is a member of the following medical societies: American Academy of Hospice and Palliative Medicine, American Academy of Pediatrics, American Heart Association, American Trauma Society, National Association of EMS Physicians, Society of Critical Care Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Barry J Evans, MD Assistant Professor of Pediatrics, Temple University Medical School; Director of Pediatric Critical Care and Pulmonology, Associate Chair for Pediatric Education, Temple University Children's Medical Center

Barry J Evans, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Pediatric Metabolic Acidosis Medication

Medication Summary

Alkalinizing agents

Class Summary

Sodium bicarbonate

Sodium bicarbonate

Tromethamine (THAM)

Tromethamine (THAM)

Vitamins

Class Summary

Thiamine

Thiamine

Pediatric Metabolic Acidosis Medication

Medication Summary

Alkalinizing agents

Class Summary

Sodium bicarbonate

Sodium bicarbonate

Tromethamine (THAM)

Tromethamine (THAM)

Vitamins

Class Summary

Thiamine

Thiamine

References

Tables

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