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Volume 6, Pages 148-153
Review Article

Apparent Bicarbonate Space in Children

1Service of Pediatrics, Hospital Nacional Prof. A. Posadas, Buenos Aires, Argentina
2Intensive Care Unit, Hospital Nacional Prof. A. Posadas, Buenos Aires, Argentina
3Department of Pediatrics, Faculty of Medicine, University of Buenos Aires, Argentina

Received 20 September 2005; Revised 4 January 2006; Accepted 13 January 2006

Academic Editor: Patricia Vallés

Copyright © 2006 Horacio A. Repetto and Roberto Penna.


The amount needed to change the concentration of a solute requires the knowledge of its volume of distribution in the solution. Electrolytes that do not participate in active metabolic reactions have a fixed volume of distribution that corresponds to the volume of water in which they solubilize. Bicarbonate infusion is used to correct hyperchloremic metabolic acidosis. Its volume of distribution (bicarbonate space) changes with its participation in the blood buffer systems. In other words, it is not a fixed physical volume, like that of other solutes. In this paper, we shall review experimental studies that supported evidence for this knowledge and analyze the basic hypothesis to explain the phenomena. Since we have not found clinical studies in children, we shall report our experience in a group of patients with metabolic acidosis treated with bicarbonate infusion in whom apparent bicarbonate space was measured and compared with data in adults from the literature. Guidelines for amount of bicarbonate needed to increase its concentration according to baseline bicarbonate concentration will be suggested.