Lactic Acidosis

Cansel YAŞARa , Ramiz YAZICIb

aAnkara Bilkent City Hospital, Clinic of Emergency Medicine, Ankara, Türkiye
aUniversity of Health Sciences Kanuni Sultan Süleyman Training and Research Hospital, Clinic of Emergency Medicine, İstanbul, Türkiye

ABSTRACT
Lactate levels above 2 mmol/L represent hyperlactatemia, whereas lactic acidosis is usually defined as a serum lactate concentration above 4 mmol/L (usually serum pH below 7.35). Lactic acidosis is the most common cause of metabolic acidosis in hospitalised patients. Lactic acidosis occurs when lactic acid production exceeds lactic acid clearance. The increase in lactate production is usually due to impaired tissue oxygenation resulting from reduced oxygen delivery or a defect in mitochondrial oxygen utilisation. Lactic acidosis occurs by 3 mechanisms: 1. Increased glycolysis 2. Decreased lactic acid metabolism (abnormal TCA cycle) 3. Increased glycolysis or abnormal TCA cycle. Primary treatment is the diagnosis and treatment of the underlying disease. Tissue hypoxia can significantly increase lactic acid production and often slows down the metabolism of lactate by the liver, heart, and kidneys. When using bicarbonate therapy in patients with lactic acidosis and severe acidemia, the aim is to maintain arterial pH above 7.1 until the primary process causing metabolic acidosis is reversed. However, if the patient has severe acute kidney injury, the aim is to increase the pH above 7.3.
Keywords: Acidosis, lactic; sodium bicarbonate; lactic acid; mitochondria

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