Is renal tubular acidosis a good treatment in children?
summary
In fact, acidosis is not common, but once it occurs, it is more urgent. In fact, renal tubular acidosis is a clinical syndrome caused by the re absorption of bicarbonate in proximal renal tubules or the functional defect of hydrogen ion excretion in distal renal tubules. Now let's share with you the good treatment of childhood acidosis?.
Is renal tubular acidosis a good treatment in children?
The first is: alkaline drugs are caused by retention of H+ in the distal renal tubules, which cause metabolic acidosis, while HCO3- is reabsorbed in proximal renal tubular acidosis. The renal threshold of bicarbonate in children is reduced to below 17 * 20mmol/L (normal 25 to 26mmol/L, and small infant is 22mmol/L). Even when plasma HCO3- is normal, the renal threshold decreases. A large amount of HCO3 - in the filtrate is discharged from the urine, causing acidosis. The application of basic drugs is to correct acidosis, early use can improve or completely disappear the clinical symptoms. There are two kinds of commonly used preparations: (1) mixture of sodium bicarbonate and citrate. Sodium bicarbonate can play a direct role in acute or chronic acidosis. The loss of bicarbonate in type I children is very little. It only needs to neutralize the acidic products in the body, and is generally given 1-5mmol / (kg · d); Type II renal tubular acidosis is treated with alkaline drugs. In addition to neutralizing the acidic products in the body, it is also necessary to compensate for the loss of bicarbonate in the urine. Therefore, it is necessary to start with 5 to 10mmol/ (kg * d), intravenous or oral, and adjust the dosage according to bicarbonate or carbon dioxide binding force and 24h urinary calcium excretion. Among them, urinary calcium excretion is a sensitive index to guide the treatment, and the dosage should be adjusted to make 24-hour urinary calcium excretion less than 2 mg / kg. Excessive dosage of sodium bicarbonate can cause abdominal distension, belching and other side effects. ② Citrate mixture: there are two kinds of preparation, one is sodium citrate, 100g potassium citrate, add water to 1000ml, 2mmol base per ml. The other is sodium citrate 100g. Citric acid 140g, add water to 1000ml, 1mmol sodium per ml. The dose was 1 mmol / (kg · d) and was taken orally 4-5 times.
Second: potassium supplement renal tubular acidosis, in addition to perchloric acidosis, due to the distal tubule nephron H + excretion disorder, H + - Na + exchange decreased, competitive K + - Na + exchange increased, resulting in excessive potassium excretion, resulting in hypokalemia; Due to the loss of large amount of NaHCO3 in proximal renal tubules, the plasma volume decreased, resulting in secondary aldosterone increase. As a result, NaCl reabsorption increased, replacing the lost NaHCO3, resulting in hyperchloremia acidosis; When there is obvious hypokalemia, we should first supplement potassium and then correct acidosis, so as not to induce hypokalemia. The citrate mixture, which often contains potassium salt, was given orally at the initial dose of 2-4 mmol / (kg · d) for 3-4 times. The maximum dose of 4-10 mmol / (kg · d) in patients with proximal renal small acidosis could maintain normal blood potassium concentration. During the treatment, the dosage was adjusted according to the condition and blood potassium concentration. Potassium chloride should be used with caution because it contains chloride ion.
Third: the application of calcium preparation in chronic acidosis can lead to the increase of urinary calcium excretion and prevent the conversion of 25 (OH) d to 1.25 (OH) 2D. In addition, the lack of gastric acid in some patients affects the intestinal absorption of calcium and makes the blood calcium low. Hypocalcemia can cause secondary hyperparathyroidism, increase phosphorus clearance, and decrease phosphate and calcium ions in blood, so that bone can't be mineralized, forming rickets; Hypocalcemia and even convulsion may appear in the process of correcting acidosis. Calcium supplement is needed. Severe hypocalcemia can be treated by intravenous drip of 10% calcium gluconate, 0.5-1.0 mg / kg or 5-10 mg / time, double dilution and slow infusion. At the same time, cardiac monitoring was carried out. When the heart rate was lower than 60 beats / min, the injection was stopped to prevent cardiac arrest. If necessary, it can be reused every 6-8 hours. Generally, low calcium can be taken orally and supplemented with 15 mg / kg calcium ion.
matters needing attention
Most cases need long-term treatment, even lifelong treatment. The pH value of blood should be determined by regular outpatient follow-up. The concentration of bicarbonate and urinary calcium excretion should be adjusted carefully. The prognosis depends on early diagnosis, early reasonable treatment and long-term regular treatment. If early and reasonable treatment can prevent severe renal calcification and renal insufficiency, the prognosis is good. If the treatment is interrupted, the clinical symptoms caused by metabolic acidosis may recur, which will lead to renal insufficiency or failure and poor prognosis.
