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Related Experiment Videos

Lactate and acid base changes in the critically ill.

G R Nimmo1, I S Grant, S J Mackenzie

  • 1Intensive Therapy Unit, Western General Hospital, Edinburgh, UK.

Postgraduate Medical Journal
|January 1, 1991
PubMed
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Metabolic acidosis and hyperlactataemia in acute illness indicate a poor prognosis. Catecholamine therapy improved these conditions in shocked patients, suggesting a beneficial role in critical care settings.

Area of Science:

  • Critical Care Medicine
  • Biochemistry
  • Physiology

Background:

  • Metabolic acidosis and hyperlactataemia are independent indicators of poor prognosis in acute illness.
  • Therapeutic strategies for lactic acidosis and the correlation of acid-base measurements with blood lactate remain debated.
  • Understanding these relationships is crucial for managing critically ill patients.

Purpose of the Study:

  • To investigate the efficacy of catecholamine therapy in patients with shock and lactic acidosis.
  • To examine the relationship between arterial and mixed venous acid-base status and blood lactate levels.
  • To document hemodynamic, oxygen transport, and acid-base changes during high-volume hemofiltration in multiple organ failure.

Main Methods:

  • Studies were conducted on shocked patients receiving catecholamine therapy.

Related Experiment Videos

  • Acid-base status (arterial vs. mixed venous) and blood lactate levels were analyzed in 32 patients.
  • Hemodynamic and acid-base parameters were monitored in 8 patients with multiple organ failure undergoing hemofiltration with lactate-buffered fluid.

    • Main Results:

    • Catecholamine therapy in shocked patients led to improvements in acidosis and hyperlactataemia, alongside cardiorespiratory benefits.
    • No significant differences were found in [H+], [HCO3], or base excess between arterial and mixed venous samples; no correlation with lactate.
    • Hemofiltration in multiple organ failure patients caused a decrease in cardiac output and oxygen delivery but maintained blood pressure; no serious acid-base derangements, though hyperlactataemia persisted due to replacement fluid.

    Conclusions:

    • Catecholamine therapy may be beneficial for shock patients with lactic acidosis, provided they are adequately monitored, resuscitated, and oxygenated.
    • Standard acid-base measurements do not reliably correlate with blood lactate levels in critically ill patients.
    • High-volume hemofiltration with lactate-containing fluid can cause hyperlactataemia without inducing severe acid-base disturbances.