Lactic Acidosis Medication

  • Author: Kyle J Gunnerson, MD; Chief Editor: Michael R Pinsky, MD, CM, FCCP, FCCM   more...
 
Updated: Jun 3, 2011
 

Medication Summary

Definite treatment for lactic acidosis is correction of the underlying cause for type A lactic acidosis and the removal of the offending drug or toxin in type B lactic acidosis.

As previously stated, controversy surrounds the use of alkali in treating lactic acidosis. Animal models of lactic acidosis have shown that intravenous administration of NaHCO3 may increase lactate production (particularly by the splanchnic bed), decrease portal vein flow, lower intracellular pH in muscle and liver, lower arterial pH, and worsen the cardiac output.

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Alkalinizing Agents

Class Summary

NaHCO3 may be used as a temporizing measure in very severe acidosis and in patients who become hemodynamically unstable because of the acidosis. Other therapies (eg, THAM and Carbicarb) are not available in the United States at present and have not been shown to be clinically effective.

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Sodium bicarbonate

 

Sodium bicarbonate is the treatment most commonly used for alcoholic ketoacidosis. Its only indication is for severe metabolic acidosis that is causing hemodynamic instability.

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Vitamins

Class Summary

Vitamins are essential for normal metabolism.

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Thiamine

 

Vitamin B-1 is used for thiamine deficiency, including Wernicke encephalopathy syndrome. It is also used in patients with lactic acidosis of no established cause. Thiamine deficiency may rarely cause lactic acidosis.

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Contributor Information and Disclosures
Author

Kyle J Gunnerson, MD  Associate Professor, Departments of Anesthesiology/CCM and Emergency Medicine, Virginia Commonwealth University School of Medicine; Associate Director, Center for Adult Critical Care, Chief, Division of Critical Care, Director of Critical Care Anesthesiology, Co-Director of Cardiac Surgery ICU, Departments of Anesthesiology and Emergency Medicine, Virginia Commonwealth University Health System

Kyle J Gunnerson, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians, American Medical Association, Society for Academic Emergency Medicine, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Cory Franklin, MD  Professor, Department of Medicine, Rosalind Franklin University of Medicine and Science; Director, Division of Critical Care Medicine, Cook County Hospital

Cory Franklin, MD is a member of the following medical societies: New York Academy of Sciences and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Chief Editor

Michael R Pinsky, MD, CM, FCCP, FCCM  Professor of Critical Care Medicine, Bioengineering, Cardiovascular Disease and Anesthesiology, Vice-Chair of Academic Affairs, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center

Michael R Pinsky, MD, CM, FCCP, FCCM is a member of the following medical societies: American College of Chest Physicians, American College of Critical Care Medicine, American Heart Association, American Thoracic Society, Association of University Anesthetists, European Society of Intensive Care Medicine, Shock Society, and Society of Critical Care Medicine

Disclosure: LiDCO Ltd Honoraria Consulting; iNTELOMED Intellectual property rights Board membership; Edwards Lifesciences Honoraria Consulting; Applied Physiology, Ltd Honoraria Consulting; Cheetah Medical Consulting fee Consulting

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Sat Sharma, MD, FRCPC,to the development and writing of the source article.

References

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Pathophysiologic classification of lactic acidosis.
 
 
 
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