Which treatments for lactic acidosis lack evidence of efficacy?

Updated: Dec 09, 2020
  • Author: Bret A Nicks, MD, MHA; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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The following agents have theoretical advantages but either have not been proven to be more effective than bicarbonate or have not been demonstrated to be effective in humans.

Tris-[hydroxymethyl] aminomethane

Tris-[hydroxymethyl] aminomethane (THAM) has theoretical advantages over bicarbonate because CO2 is not generated. This agent has been studied in animals and humans but has not been proven to be more effective than bicarbonate.


Carbicarb is a combination of sodium carbonate and sodium bicarbonate that buffers comparably to bicarbonate but does not generate CO2. Although this theoretical advantage should favor its use over bicarbonate, there is no evidence in humans to support improved outcomes.


Dichloroacetate is not a buffer, but this agent stimulates the oxidation of pyruvate. This has resulted in improved lactate utilization and increased tissue levels of adenosine-triphosphate (ATP). However, prospective studies have failed to demonstrate its efficacy.

Miscellaneous agents

Coenzyme Q, l-carnitine, and riboflavin have been used to treat lactic acidosis due to antiretroviral therapy, without definitive demonstration of efficacy.

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