Disseminated intravascular coagulation and refractory shock induced by splanchnic metabolic acidosis

In eight dogs, acidosis was induced by the infusion of lactic acid into the superior mesenteric artery in a dose of 5.0 to 12.5 millimoles per kilogram during a 30 minute period. Four dogs out of five in which the lowest pH of arterial blood was lower than 7 developed a typical acute disseminated intravascular coagulation, accompanied by a sudden elevation of arterial and portal venous pressure. In these four dogs, refractory shock developed between 0.5 and five hours after lactic acid infusion. The other four without disseminated intravascular coagulation maintained a normal blood pressure and survived until sacrifice six hours after infusion. In two dogs, systemic infusion of 10 millimoles per kilogram was performed in the same interval as the former. Both died from cardiac failure without occurrence of disseminated intravascular coagulation before the infusion was completed. The dogs with disseminated intravascular coagulation revealed a marked deterioration of coagulative system and generalized thrombi in the intestine, liver, lung and kidney. Minimal changes in these parameters were observed in the dogs without disseminated intravascular coagulation. The results suggest that the infusion of lactic acid into the superior mesenteric artery is a convenient model for the production of disseminated intravascular coagulation and resultant shock.