What is the initial treatment for lactic acidosis?

Updated: Dec 09, 2020
  • Author: Bret A Nicks, MD, MHA; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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In addition to acute resuscitative and general supportive measures, identification and discontinuation of any offending agents and treatment of known pathology should occur promptly. Treatment should include source control (ie, administration of appropriate antibiotics, surgical drainage or debridement, chemotherapy for malignancy, discontinuation of potentially causative medications, dietary modification in inborn errors of metabolism), fluid resuscitation, embolic obstructive processes, and further differential diagnosis, exploration, and reassessment.

Treatment with buffering agents for acute lactic acidosis remains controversial.  However, there is a growing body of literature showing the benefit of acute medical intervention, optimal resuscitation (including condition-specific, goal-directed therapies) and lactate clearance. [9]

Aside from resuscitation measures, including adequate intravenous access, fluid resuscitation, and airway stabilization in all potentially critically ill patients, hemoperfusion or hemodialysis may be indicated in association with ethylene glycol, methanol, salicylate, and other related poisonings. Dialysis may also be useful when severe lactic acidosis exists in the setting of renal failure or congestive heart failure, as well as with severe metformin intoxication. Several studies related to metformin-related lactic acidosis and acute kidney failure found significantly reduced morbidity and mortality related to continuous renal replacement therapy (CRRT) or hemodialysis.  [10, 11]

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