[Lactate acidosis: a rare or common disease?]

Area of Science:

• Internal Medicine
• Critical Care
• Biochemistry

Context:

• A 5-year survey of 50 documented cases of severe hyperlactataemia (≥ 4 mmol/l) in patients hospitalized at a regional internal medicine department.
• Investigated potential causes including liver involvement, cardiogenic shock, sepsis, and biguanide administration.
• Observed common clinical presentations such as dehydration, vomiting, and diarrhea, often with altered consciousness.

Purpose:

• To assess the incidence and clinical characteristics of metabolic lactic acidosis (MLAC) in a general hospital setting.
• To identify common triggers and associated clinical findings of severe hyperlactataemia.
• To highlight diagnostic challenges and the importance of lactate level assessment.

Summary:

• Biguanide administration was the probable cause in 21 cases, while liver disease, cardiogenic shock, and sepsis accounted for others.
• Severe hyperlactataemia was frequently associated with decreased blood pH and base excess, though typical acidosis signs were often absent.
• Hypochloremia and hypocapnia sometimes masked acidosis, presenting with normal or elevated pH levels.

Impact:

• MLAC is not rare, but its diagnosis relies heavily on clinician awareness and lactate level testing.
• The study underscores that classic signs of acidosis may be absent, necessitating a high index of suspicion.
• Emphasizes the need for routine lactate level measurement in patients with suspected metabolic disturbances.