Lactic Acidosis: The Case Against Bicarbonate Therapy

Excerpt

Lactic acidosis is perhaps the commonest and most poorly treated acid-base disorder. If a blood lactate concentration of at least 5 meq/L (5 mmol/L) and an arterial pH of 7.2 or less are the criteria, the reported incidence of lactic acidosis among adult hospitalized patients not having surgery is about 1% (1). Approximately 60% to 70% of all patients with lactic acidosis die (1, 2) and, among those in whom hypotension coexists, mortality approaches 100% (3-6).Based on these statistics alone, the conclusion is inescapable that present therapy for lactic acidosis is inadequate. Not as readily apparent, however, is whether any