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Lactic acidosis.

B A Mizock1

  • 1Division of Critical Care Medicine, Chicago Medical School, Illinois.

Disease-A-Month : DM
|April 1, 1989
PubMed
Summary

Understanding lactic acidosis in critically ill patients is key. Occult hypoperfusion can occur even without obvious signs, impacting diagnosis and treatment strategies for lactic acidosis.

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Area of Science:

  • Critical Care Medicine
  • Biochemistry
  • Pathophysiology

Background:

  • Lactic acidosis pathophysiology is vital for critically ill patient care.
  • Current classification relies on tissue hypoperfusion signs, but occult hypoperfusion exists.
  • Diagnostic criteria (pH < 7.35, lactate > 5-6 mM/L) may miss subtle cases.

Purpose of the Study:

  • Review lactic acidosis biochemistry and controversial aspects.
  • Highlight diagnostic and therapeutic implications of occult hypoperfusion.
  • Discuss controversies surrounding bicarbonate therapy and explore alternatives.

Main Methods:

  • Review of lactic acidosis pathophysiology and biochemistry.
  • Analysis of current classification systems and diagnostic criteria.
  • Evaluation of diagnostic tools like the oxygen flux test.
  • Discussion of therapeutic strategies, including bicarbonate use and alternatives.

Main Results:

  • Occult hypoperfusion is present in some lactic acidosis cases lacking clinical signs.
  • The oxygen flux test may aid in diagnosing low-grade lactate elevations.
  • Blood lactate concentration shows prognostic value, particularly in shock patients.

Conclusions:

  • Recognizing occult hypoperfusion is crucial for managing lactic acidosis.
  • Bicarbonate therapy for lactic acidosis remains controversial due to potential adverse effects.
  • Prognostic utility of lactate levels varies depending on patient condition, especially shock.

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