Management of metabolic acidosis in acute gastro-enteritis.

Thle management of gastro-enteritis with dehydration and electrolyte and acid-base disturbances presents one of the commonest clinical problems in hospital paediatric practice in Capetown. A large proportion of the 150,000 attendances at the outpatient department of the Red Cross War Memorial Children's Hospital are concerned with gastro-enteritis. During the summer months up to 90 or more dehydrated infants a day receive intravenous fluid therapy in the " drip-room." Under these conditions it is not possible or practicable to correct biochemical derangements in each infant individually under laboratory control. Schemes of management have had to be devised which could deal with the majority of cases satisfactorily. Biochemical control could then be reserved for severely ill infants or those who failed to respond to the standard regimen. The use of half-strength Darrow's-2.5 % dextrose as a standard solution for intravenous therapy in all cases of gastroenteritis managed in the drip-room has proved to be simple and effective. It is unassociated with possible iatrogenic electrolyte or other disturbances (Hansen, 1957 ; Bowie, 1960; RainierPope, 1962). This report deals with an assessment of (a) the effectiveness of this standard regimen, and (b) the possible beneficial effects of adding sodium bicarbonate to the above solution for the correction of the acid-base disturbances encountered in these infants. All infants were excluded from the trial who were moribund on admission or had arterial pH values below 7. In these infants the acidosis was rapidly corrected by intravenous 4% sodium bicarbonate solution followed by the Darrow's-dextrose solution with added sodium bicarbonate.