What are the goals of drug treatment for lactic acidosis?

Updated: Aug 18, 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 advocated in the setting of severe acidosis when physiologic uncoupling occurs. In addition, it has also been demonstrated that bicarbonate therapy alone does not improve hemodynamics in the critically ill patient with lactic acidosis, and this treatment may induce a paradoxical worsening acidosis in brain tissues. [16, 17] 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.

It seems somewhat intuitive that acidosis should be corrected and homeostasis maintained for physiologic functions to return. However, large studies have been conducted that do not necessarily support this approach. 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.

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