Lactic acidosis natural history, complications and prognosis
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Underlying sepsis or any type of shock in a critically ill patient may lead to hyperlactaemia, which is an independent predictor of death. 80% of the patients die in intensive care when their serum lactate values reach >10 mmol/l, and if the severe lactic acidosis persists for 48 hours, mortality is 100%[1]. Increased lactate levels require immediate diagnostic work-up and classification.
The determination of the lactate serum concentrations, and close follow-up is recommended in the first hour of admission for a patient with suspected sepsis[2]. In addition, blood cultures, broad-spectrum antibiotics, fluid resuscitation and vasopressor administration are recommended within the first hour. Increased lactate levels (≥4 mmol/l) along with refractory hypotension warrant large amounts of crystalloids, and rate of infusion must be managed according to lactate clearance. Factors affecting lactate metabolism must be monitored, for example liver function impairment reduces clearance. Lactate levels on admission are associated with organ failure and mortality in patients with liver disease.
In patients with baseline lactate levels above 5 mmol/l, their 12-hour lactate clearance is monitored for a predictive prognosis for survival with greater clearance signifying better prognosis (lower levels of lactate lead to better outcomes), while the absolute lactate level is an independent predictor for the severity of the underlying disease even after correction[3].
References
- ↑ Kluge S, de Heer G, Jarczak D, Nierhaus A, Fuhrmann V (2018). "[Lactic acidosis - update 2018]". Dtsch Med Wochenschr. 143 (15): 1082–1085. doi:10.1055/a-0585-7986. PMID 30060277.
- ↑ Levy MM, Evans LE, Rhodes A (2018). "The Surviving Sepsis Campaign Bundle: 2018 update". Intensive Care Med. 44 (6): 925–928. doi:10.1007/s00134-018-5085-0. PMID 29675566.
- ↑ Coba V, Whitmill M, Mooney R, Horst HM, Brandt MM, Digiovine B; et al. (2011). "Resuscitation bundle compliance in severe sepsis and septic shock: improves survival, is better late than never". J Intensive Care Med. 26 (5): 304–13. doi:10.1177/0885066610392499. PMID 21220270.