title: Decreased serum bicarbonate as a manifestation of undernutrition secondary to nonorganic failure-to-thrive.
abstract: Eight of 101 children (8%) seen serially in consultation in an outpatient failure-to-thrive (FTT) clinic had isolated serum bicarbonate (TCO2) levels between 16 and 20 MEQ/dL (normal 22 to 30 MEQ/dL). None of these eight patients had signs or symptoms of renal disease, and all had nonorganic etiologic factors associated with their malnutrition. At the time of this review, follow-up TCO2 measurements were available for seven of the eight children who had attained normal weight (wt/age greater than fifth percentile on National Center for Health Statistics (NCHS) growth chart). All these children had normal TCO2 levels and no evidence of renal disease on follow-up more than 12 months later. Clinicians treating undernourished children who have low TCO2 measurements and have no signs or symptoms of renal disease and identified nonorganic factors, should consider a trial of therapies directed at nonorganic factors. Clinicians should be aware that a high percentage of undernourished children without other medical disease may have abnormal TCO2 measurements that correct after the institution of adequate caloric intake.
authors.affiliation: Department of Medicine, Children's Hospital, Boston, MA 02115.
authors.forename: W G
authors.initials: WG
authors.lastname: Bithoney
authors.forename: D
authors.initials: D
authors.lastname: Epstein
authors.forename: M
authors.initials: M
authors.lastname: Kim
mesh_terms: D000141:Acidosis, Renal Tubular / Q000097:blood / Q000175:diagnosis; D001639:Bicarbonates / Q000097:blood*; D002675:Child, Preschool; D003937:Diagnosis, Differential; D002149:Energy Intake / Q000502:physiology; D005183:Failure to Thrive / Q000097:blood / Q000175:diagnosis*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D011502:Protein-Energy Malnutrition / Q000097:blood / Q000175:diagnosis*
chemical_list: D001639:Bicarbonates