Controversies in lactic acidosis. Implications in critically ill patients

Area of Science:

• Critical care medicine
• Physiology
• Biochemistry

Background:

• Lactic acidosis is a frequent complication in critically ill patients.
• It is typically associated with inadequate tissue perfusion and oxygen delivery.
• However, lactic acidosis can also manifest when tissue perfusion appears sufficient, indicating complex underlying mechanisms.

Purpose of the Study:

• To clarify the multifaceted nature of lactic acidosis in critical illness.
• To address controversies surrounding its pathogenesis, diagnosis, treatment, and prognosis.
• To aid clinicians in managing patients with lactic acidosis.

Main Methods:

• Review of existing literature on lactic acidosis in critical care.
• Analysis of clinical data pertaining to hyperlactatemia and acidosis.
• Discussion of controversial aspects in the field.

Main Results:

• Lactic acidosis is commonly linked to inadequate tissue perfusion.
• Hyperlactatemia (elevated blood lactate) can occur without acidosis, often in hypermetabolic states.
• Significant controversies persist regarding the diagnosis, treatment, and prognosis of lactic acidosis.

Conclusions:

• Understanding the controversies in lactic acidosis is crucial for effective clinical management.
• Distinguishing between lactic acidosis and hyperlactatemia is important for appropriate therapeutic strategies.
• Further research is needed to resolve ongoing debates in the field.