Evaluation and Management of Metabolic Alkalosis in Children

This paper reviews the pathophysiology, diagnostic evaluation, and treatment strategies for pediatric patients with metabolic alkalosis. The goal is to provide pediatric clinicians a framework to understand the underlying reasons for metabolic alkalosis, and to grasp the need to identify and treat the primary problem as well as the barriers that prevent adequate renal compensation to correct this acid–base disorder.

The strategy for metabolic alkalosis management lies in understanding of basic pathophysiology. With innovations in genetic testing and drug development, more precise diagnoses with targeted intervention are possible. Understanding which children are at high risk for this disorder gives clinicians the ability to prevent and intervene early to reduce morbidity.

Metabolic alkalosis is one of the most common acid-base disturbances in hospitalized children. Pediatric cardiothoracic surgery patients are at high risk for development of metabolic alkalosis. The importance of careful history and physical examination, and measurement of urinary chloride to help identify primary renal and non-renal drivers of alkalosis, is essential. Understanding the pathophysiology of metabolic alkalosis directs treatment and management of the condition.