Lactic acidosis: From sour milk to septic shock

Pamela J. Fall, Harold M. Szerlip

Research output: Contribution to journalReview articlepeer-review

138 Scopus citations

Abstract

Lactic acidosis is frequently encountered in the intensive care unit. It occurs when there is an imbalance between production and clearance of lactate. Although lactic acidosis is often associated with a high anion gap and is generally defined as a lactate level >5 mmol/L and a serum pH <7.35, the presence of hypoalbuminemia may mask the anion gap and concomitant alkalosis may raise the pH. The causes of lactic acidosis are traditionally divided into impaired tissue oxygenation (Type A) and disorders in which tissue oxygenation is maintained (Type B). Lactate level is often used as a prognostic indicator and may be predictive of a favorable outcome if it normalizes within 48 hours. The routine measurement of serum lactate, however, should not determine therapeutic interventions. Unfortunately, treatment options remain limited and should be aimed at discontinuation of any offending drugs, treatment of the underlying pathology, and maintenance of organ perfusion. The mainstay of therapy of lactic acidosis remains prevention.

Original languageEnglish (US)
Pages (from-to)255-271
Number of pages17
JournalJournal of Intensive Care Medicine
Volume20
Issue number5
DOIs
StatePublished - Sep 1 2005

Keywords

  • Bicarbonate
  • Hemofiltration
  • Hypoperfusion
  • Hypoxia
  • Lactate
  • Lactic acidosis
  • Pyruvate
  • SIRS
  • Shock

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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