Abstract: Objectives of this study were to investigate the characteristics of
metabolic acidosis associated with rotavirus gastroenteritis and to explore
them as a tool in the management of dehydration. The study was retrospective,
case record based and conducted in a secondary level District General Hospital.
Included study population were 133 children who were admitted to the Paediatric
Unit with rotavirus gastroenteritis. Degree of dehydration, result of blood gas
analysis, C-reactive protein level, urinary ketones, renal function tests,
fluid management and duration of hospitalization were recorded and results
compared between patients with and without severe metabolic acidosis (serum
bicarbonate < 17 mmol/L). Out of 133 patients, blood gas analysis was
obtained in 78 (59%) and 73 (94%) of those showed metabolic acidosis
(bicarbonate < 22 mmol/L). Thirty five patients developed severe metabolic
acidosis. Patients with severe metabolic acidosis showed signs of dehydration
more commonly (97% vs. 74%, p< 0.05) and required intravenous
rehydration more frequently (94% vs. 63%, p< 0.05) than those who
were not severely acidotic. With respect to gender ratio, initial temperature,
serum levels of C-reactive protein, chloride, anion-gap, lactate and ketonuria,
there were no significant differences between the severely acidotic patients
and those who were not. Urea and creatinine levels were higher (46.6 (11.7)
versus 37.8 (11.9) micromole/L for creatinine and 5.5 (1.9) versus 4.2 (2.1)
mmol/L for urea, p< 0.05) in patients with severe metabolic acidosis and
correlated significantly negatively (for both: r=− 0.29, p=0.02) with
serum bicarbonate levels. We concluded that the majority of children attending
hospital with rotavirus gastroenteritis had a metabolic acidosis. Severe
metabolic acidosis was associated with more severe dehydration and higher urea
and creatinine levels and increased requirement for intravenous fluid boluses
and intravenous rehydration. A bicarbonate level of > 17 mmol/L excluded
severe clinical dehydration and below this level a degree of dehydration was very likely.
