What are the goals of drug 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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One of the primary goals in treating critically ill patients is maximizing systemic oxygen delivery. Much debate has surrounded the potential use of buffering agents (specifically bicarbonate) to reverse the potentially negative effects of acidosis, but their use is generally only advocated in the setting of severe acidosis when physiologic uncoupling occurs, as well as in unique toxicologic situations and specific renal dysfunction. Additionally, it has been demonstrated that bicarbonate therapy alone does not improve hemodynamics in the critically ill patient with lactic acidosis, and this treatment may induce a paradoxic worsening acidosis in brain tissues. [20, 21] In patients unable to reclaim bicarbonate (eg, renal failure, renal tubular acidosis), treatment concurrent with ongoing resuscitative measures based on the acute disease process identified should be considered when appropriate.

While it is physiologically intuitive that acidosis should be correctable through buffering interventions and homeostasis optimized for physiologic functions, large studies have been conducted that do not necessarily support this approach. Below are some unique considerations regarding when such treatment may be appropriate. However, before the initiation of pharmacologic buffering therapy, consultation with a critical care specialist and/or nephrologist should be considered to determine the optimal course of action, so as to avoid paradoxical acidosis.

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