Diagnosis and treatment of severe metabolic acidosis

Severe non-respiratory acidosis is a frequent biochemical finding in sick children. While treatment is usually straightforward and comprises managing the underlying illness and giving supportive care, in some cases the acidosis itself requires specific therapy. The authors provide an approach to the diagnosis, investigation and management of children with severe metabolic acidosis, using the anion gap (adjusted for serum albumin) as a guide to the aetiology. Lactic acidosis, ketosis and organic acids are discussed, as are specific treatments and the general use of sodium bicarbonate as a base.