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儿童代谢性酸中毒概述

Authors
Mahesh Sharman, MD, FAAP
Ashok P Sarnaik, MD, FAAP, FCCM
Section Editor
Tej K Mattoo, MD, DCH, FRCP
Deputy Editor
Melanie S Kim, MD
Translators
李明, 主治医师

引言

代谢性酸中毒的婴儿和儿童可表现为不同程度的急慢性疾病，从看似健康到严重虚脱不等。详细的病史采集和体格检查有助于指导准确评估特定的病理生理过程。

儿童代谢性酸中毒的生理学、鉴别诊断和治疗的概述将总结在此。成人代谢性酸中毒的相关内容参见其他专题。 (参见“成人代谢性酸中毒概述”)

酸碱平衡

为了更好地认识导致代谢性酸中毒的各种临床病症，对酸生成和酸排泄的基本生理原理进行回顾十分重要。在正常的生理情况下，儿童每日产生2-3mEq/kg非挥发性酸，主要为含硫氨基酸代谢产生的硫酸。为了维持稳态，这些氢离子必须随尿液排泄。

酸碱平衡是通过初始酸负荷缓冲及随后经尿液排泄维持的。

缓冲物 — 初始缓冲物主要先是细胞外液中的碳酸氢根(HCO3-)，随后是细胞中的蛋白质和磷酸根。下列等式表达了碳酸氢盐-二氧化碳缓冲系统，该等式基于Brønsted-Lowry酸碱定义：

                          

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Literature review current through: 2017-06 . | This topic last updated: 2016-07-05.
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