ABSTRACT
This chapter presents a review of maturational acid-base physiology and a variety of specific problems of acid-base balance that are unique to infants and children. Much of the material underscores the different physiology of the infant compared to the adult. The kidney of the premature infant is unable to compensate for the frequent respiratory and metabolic disturbances encountered in the nursery. Thus, acid-base balance is very precarious for the sick low-birth-weight infant. The process of growth is also unique to infants and children and requires special understanding and management. Growth induces an additional acid load that must be handled by a maturing kidney, thus placing the newborn at continual risk for metabolic acidosis. Metabolic acidosis and alkalosis impair growth and cause failure to thrive, so that correction of these disorders is urgent and critical in pediatrics. Acid-base disorders specific to the pediatric population also include inherited metabolic and tubular transport problems. Such patients have not often been seen by internists, in part because they failed to live to adulthood. Now more and more affected children are living longer and enjoying a better quality of life. As adults, they will require medical care by internists and other physicians not familiar with pediatric diseases. Therefore, this review should provide information that will improve the care of young
adults with inherited tubulopathies, errors of metabolism, and other acidbase disturbances.
