Causes and Effects of lactic acidosis

For those that missed the Patient Safety Conference today, we had a case of metformin induced lactic acidosis. While we often see lactic acidosis due to hypoperfusion, there are alternative causes for increased accumulation of lactate and decreased clearance of lactate. We will often see resulting lactic acidosis as a multifactorial cause (ex: hypoperfusion with decreased clearance due to liver dysfunction). Featured image Similarly, it is important to recognize the metabolic consequence of severe acidosis, no matter what the etiology:

  • Compensatory hyperventilation
  • Shift of the oxyhemoglobin curve to the right
  • Depressed myocardial contractility, eventually leading to bradycardia
  • Initial sympathetic response leading to tachycardia and increased arrhythmias
  • Resistance to the effects of catecholamines
  • Peripheral vasodilatation leading to hypotension
  • Pulmonary vasoconstriction
  • Cellular shift of K out of cells leading to hyperkalemia and cardiac complications