Which of the following medicines is used to correct metabolic acidosis in a newborn?

UPRVUNL - 2021

Child Health Nursing (Pediatrics)

Easy

Appeared in: UPRVUNL - 2021

Explanation

Sodium Bicarbonate directly provides bicarbonate ions (HCO₃⁻) to the bloodstream.
These bicarbonate ions buffer excess hydrogen ions (H⁺), which are the cause of acidosis, thereby raising the blood pH.
It is the specific pharmacological agent indicated for the correction of severe metabolic acidosis when other measures have failed.
In newborns, a specific low concentration (4.2%) must be used to prevent severe complications like intracranial hemorrhage.

Option B: Normal Saline (NS) is a crystalloid solution used for volume expansion to treat hypovolemia and shock. It does not contain a buffer and cannot directly correct metabolic acidosis.
Option C: Adrenaline (Epinephrine) is a catecholamine used to increase heart rate and cardiac contractility. Its primary indication in neonatal resuscitation is severe bradycardia (heart rate below 60 bpm despite effective ventilation) or cardiac arrest.
Option D: Ringer Lactate (RL) is a balanced crystalloid solution for fluid replacement. While the liver metabolizes the lactate in RL to bicarbonate, this process is slow and depends on adequate liver function. It is not used for the acute, rapid correction of severe metabolic acidosis in a newborn.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Pharmacological management of neonatal metabolic acidosis as background academic context rather than a clinical decision trigger.
A nurse's primary responsibility is patient safety. Using the wrong concentration (8.4% instead of 4.2%) of Sodium Bicarbonate in a newborn can be a fatal medication error, leading to brain hemorrhage.
Nurses must ensure that adequate ventilation is established before administering bicarbonate. Giving it to a poorly ventilated baby can paradoxically worsen intracellular acidosis and lead to a poorer outcome.
What if the newborn's metabolic acidosis is caused by poor tissue perfusion (shock)? The priority action would be to administer a volume expander like Normal Saline (10 mL/kg) first to restore circulation. Bicarbonate would only be considered if severe acidosis persists despite adequate ventilation and circulation.

How to Approach the Question

First, identify the core clinical problem in the question: 'metabolic acidosis in a newborn'.
Next, analyze the function of each medication offered in the options in the context of neonatal care.
Recall the specific pharmacological treatments for acid-base imbalances. The goal is to find a substance that acts as a base or buffer.
Evaluate the options: Sodium Bicarbonate is a direct buffer. NS and RL are primarily for volume. Adrenaline is for heart rate.
Select the option that directly counteracts the acidosis. Sodium Bicarbonate is the only option that directly provides bicarbonate to buffer the acid.
Consider the specific patient population ('newborn') to confirm if there are any special considerations, which reinforces the choice and highlights safety precautions.

Concept Tested & Keywords

Concept Tested: Pharmacological management of neonatal metabolic acidosis.
Stem keywords: medicines, correct, metabolic acidosis, newborn
Lead-in keywords: Which
Clinical cues: The term 'newborn' is a critical cue, indicating that age-specific pharmacological principles, such as drug concentration and administration risks, are highly relevant.
Negative lead-in flag: false

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E6 Ghai Essential Pediatrics(pp 26-904 of 913) p. 70-72

E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 563-565