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Medication

Medication Summary

Definitive 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.

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. Tromethamine is a buffering agent that does not generate carbon dioxide.

Sodium bicarbonate

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Sodium bicarbonate is commonly used for severe metabolic acidosis with associated hemodynamic instability, although this practice remains controversial.

Tromethamine (Tham)

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Tromethamine confers a theoretical benefit over sodium bicarbonate as it does not generate carbon dioxide. The effects on patient outcomes are not known.

Class Summary

Vitamins are essential for normal metabolism.

Thiamine

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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.

Questions

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Media Gallery

Pathophysiologic classification of lactic acidosis.

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Author

Kyle J Gunnerson, MD Associate Professor, Departments of Emergency Medicine, Anesthesiology, and Internal Medicine, University of Michigan Health System; Chief, Division of Emergency Critical Care; Medical Director of the Emergency Critical Care Center, University of Michigan 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, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Carrie E Harvey, MD, MS Assistant Professor, Department of Emergency Medicine, Michigan Medicine

Carrie E Harvey, MD, MS is a member of the following medical societies: Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Michael R Pinsky, MD, CM, Dr(HC), FCCP, FAPS, MCCM Professor of Critical Care Medicine, Bioengineering, Cardiovascular Disease, Clinical and Translational Science and Anesthesiology, Vice-Chair of Academic Affairs, Department of Critical Care Medicine, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine

Michael R Pinsky, MD, CM, Dr(HC), FCCP, FAPS, MCCM is a member of the following medical societies: American College of Chest Physicians, American College of Critical Care Medicine, American Thoracic Society, European Society of Intensive Care Medicine, Society of Critical Care Medicine

Disclosure: Received income in an amount equal to or greater than $250 from: Baxter Medical, Exostat, LiDCO<br/>Received honoraria from LiDCO Ltd for consulting; Received intellectual property rights from iNTELOMED.

Additional Contributors

Cory Franklin, MD Professor, Department of Medicine, Chicago Medical School at 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, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Acknowledgements

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

Lactic Acidosis Medication

Medication Summary

Alkalinizing Agents

Class Summary

Sodium bicarbonate

Sodium bicarbonate

Tromethamine (Tham)

Tromethamine (Tham)

Vitamins

Class Summary

Thiamine

Thiamine

Lactic Acidosis Medication

Medication Summary

Alkalinizing Agents

Class Summary

Sodium bicarbonate

Sodium bicarbonate

Tromethamine (Tham)

Tromethamine (Tham)

Vitamins

Class Summary

Thiamine

Thiamine

References

Tables

Contributor Information and Disclosures

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