Lactic Acidosis in Children—Pathophysiology, Diagnosis, and Treatment: A Workbook Exercise
Marc Yudkoff MD1
Fred Burg MD1
1 Division of Biochemical Development and Molecular Disease, Children's Hospital of Philadelphia, and University of Pennsylvania Medical Center, The School of Medicine, G3, Philadelphia, PA 19104
This article is designed to give you an opportunity to learn how lactic acidosis affects children, and how to diagnose and treat a child with this disorder. The process we have utilized is an interactive one in which you will be presented with questions commingled with problems and discussion.
CASE REPORT
A 3-month-old male infant had been well until two days prior to admission, when he had developed fever, vomiting, and diarrhea. Initially the vomiting and diarrhea were mild, and a pediatrician recommended administration of clear liquids. On the day of admission the infant ate nothing at all, vomited every one to two hours, and had more than ten stools, all of which consisted primarily of water. The parents reported that by 5 PM the child became suddenly pale and his skin seemed cool, although when they took the rectal temperature it was 37.7 C(100 F). The baby became increasingly lethargic and limp. By 6 PM, when the parents rushed the child to the emergency room, he could not be awakened at all.
The receiving physician in the emergency room found an unresponsive flaccid baby with a respiratory rate of 62 breaths per minute. A feeble pulse was 154 beats per minute and the rectal temperature was 38.1 C. The odor of acetone was apprent in the baby's breath.
