LECTION
Intensive Care
doi: 10.25005/2074-0581-2026-28-1-112-121
METABOLIC ALKALOSIS IN PEDIATRIC INTENSIVE CARE PRACTICE

YU.V. BYKOV1,2, A.N. OBEDIN1,3, E.V. VOLKOV1,5, O.V. ZINCHENKO1, I.V. YATSUK1,6

1Stavropol State Medical University, Stavropol, Russian Federation
2Regional Children's Clinical Hospital, Stavropol, Russian Federation
3Stavropol Regional Clinical Perinatal Center No. 1, Stavropol, Russian Federation
4Shpakovskaya District Hospital, Mikhaylovsk, Russian Federation
5City Clinical Hospital of Emergency Medical Care, Stavropol, Russian Federation
6Stavropol City Clinical Emergency Hospital, Stavropol, Russian Federation

A literature review was conducted on the etiopathogenesis, clinical manifestations, and intensive care management of metabolic alkalosis (MA) in children and adolescents. The search was performed in the Cochrane Library, PubMed, ScienceDirect, and Medscape databases using the following keywords: “acid-base balance”, “metabolic alkalosis”, “bicarbonate”, “hypochloremia”, “children and adolescents”, “intensive care”, and “acetazolamide”. Sources published over the past 10 years (2014-2024) were included. The inclusion criteria were the presence of information describing the etiology, pathogenesis, clinical manifestations, and the specific features of intensive care management in pediatric practice. The exclusion criterion was publications containing data on the etiopathogenesis, clinical presentation, and treatment of MA in adult patients.

Despite the high prevalence of MA in children and adolescents, this acid-base metabolism disorder often remains undiagnosed, including among intensive care patients, which is associated with a significant increase in mortality. The main causes of MA include gastrointestinal loss of acids or chlorides, administration of exogenous alkali, and excessive renal bicarbonate reabsorption. Severe MA leads to decompensation of the nervous, respiratory, and cardiovascular systems, as well as electrolyte disturbances. Assessment of the MA type and severity is based on measurement of urinary chloride, blood pH, and blood gas parameters. Intensive care management of MA includes fluid therapy, correction of electrolyte disorders, and the use of diuretics (acetazolamide). In severe, treatment-resistent cases, extracorporeal detoxification techniques are used. During treatment, it is important to eliminate/ minimize the main triggers and to correctly identify the clinical form of MA

Keywords: Acid-base balance, metabolic alkalosis, bicarbonate, hypochloremia, children and adolescents, intensive care, acetazolamide.

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Authors' information:

Bykov Yuriy Vitalyevich,
Candidate of Medical Sciences, Associate Professor of the Department of Anesthesiology and Intensive Care with a Course of Additional Professorial Education, Stavropol State Medical University; Anesthesiologist-Reanimatologist, Regional Children's Clinical Hospital
ORCID ID: 0000-0003-4705-3823
E-mail: yubykov@gmail.com

Obedin Aleksandr Nikolaevich,
Doctor of Medical Sciences, Associate Professor, Head of the of Department of Anesthesiology and Intensive Care with a Course of Additional Professional Education, Stavropol State Medical University; Deputy Chief Physician for Pediatric Care, Stavropol Regional Clinical Perinatal Center No. 1
ORCID ID: 0000-0002-9990-7272
Е-mail: volander@mail.ru

Fischer Vasiliy Vladimirovich,
Candidate of Medical Sciences, Associate Professor of the Department of Anesthesiology and Intensive Care with a Course of Additional Professional Education, Stavropol State Medical University; Deputy Chief Medical Officer, Shpakovskaya District Hospital
ORCID ID: 0000-0002-9841-6930
Е-mail: vvfisher26@gmail.com

Volkov Evgeniy Vladimirovich,
Candidate of Medical Sciences, Associate Professor of the Department of Anesthesiology and Intensive Care with a Course of Additional Professional Education, Stavropol State Medical University; Head of the Department of Anesthesiology and Intensive Care No. 1, Stavropol Regional Clinical Hospital
ORCID ID: 0000-0002-9841-6930
Е-mail: volkov26@mail.ru

Zinchenko Oleg Vasilievich,
Candidate of Medical Sciences, Associate Professor of the Department of Anesthesiology and Intensive Care with a Course of Additional Professional Education, Stavropol State Medical University
ORCID ID: 0000-0003-4729-5101
Е-mail: regionar2008@yandex.ru

Yatsuk Ivan Viktorovich,
Candidate of Medical Sciences, Associate Professor of the Department of Anesthesiology and Intensive Care with a Course of Additional Professional Education, Stavropol State Medical University; Head of the Department of Anesthesiology and Intensive Care No. 1, Stavropol City Clinical Emergency Hospital
ORCID ID: 0000-0001-5482-8581
Е-mail: yatsukiv@gmail.com

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The authors did not receive financial support from manufacturers of medicines and medical equipment

Conflicts of interest: No conflict

Address for correspondence:

Bykov Yuriy Vitalyevich
Candidate of Medical Sciences, Associate Professor of the Department of An- esthesiology and Intensive Care with a Course of Additional Professional Edu- cation, Stavropol State Medical University; Anesthesiologist-Reanimatologist, Children's City Hospital

355031, Russian Federation, Stavropol, Mira str., 310

Теl.: +7 (962) 4430492

E-mail: yubykov@gmail.com


This work is licensed under a Creative Commons Attribution 4.0 International License.

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