[The disease entity of lactate acidosis. 3. Lactate as a metabolic product]

High blood lactate concentrations can be achieved by means of intravenous bicarbonate infusion. Metabolic production of lactic acid in this case is a compensation mechanism for the alcalosis induced by bicarbonate. This metabolic condition is called lactate alcalosis. The meaning and the diagnostic value of the lactate/pyruvate quotient and of excess lactate are discussed. A metabolic increase of the lactate/pyruvate quotient (normal values being 10-20) can be attained during the intravenous application of polyalcohols (like xylitol or sorbitol) or of ethanol. In these cases blood lactate concentration remains approximately normal. The alterations are due to the metabolism of the alcohols predominantly in the cytoplasmic compartment of the hepatocytes. The anion-gap is caused by the fact that the anions are considered only in part. However, the diagnostic value of the anion-gap is only minimum. An increase in the anion-gap with a simultaneous decrease in blood-pH is not significant for a lactate acidosis.