eonatal Acid Base Balance and Disturbances

aintaining acid base balance presents a considerable challenge to the growing neonate. The infant ust ingest protein for growth and development. The metabolism of sulfur containing amino acids eads to the production of protons that must be secreted by the kidney. In addition, the formation of ydroxyapatite for the mineralization of growing bone also leads to acid production. Thus, the rowing infant must excrete approximately 2 to 3 mEq of acid per kilogram of body weight per day o avoid becoming acidotic. The mechanisms for excreting acid undergo complex maturational hanges that predispose the neonate, and the premature neonate in particular, to a great risk for the evelopment of acidosis. In addition, infants are susceptible to gastrointestinal disturbances that can ead to acidosis due to acute loss of bicarbonate in the stool. The kidney is then responsible for the roduction of new bicarbonate to restore the body’s acid base balance. There are also a number of nherited disorders in the kidney that affect acid secretion and lead to acid base disturbances in eonates. This review discusses the mechanisms by which the kidney is capable of excreting acid as ell as the developmental regulation of these processes and the basis of inherited disorders of cidification. 2004 Elsevier Inc. All rights reserved.