Severe Hyperlactatemia with Normal Base Excess
Author Information
Author(s): Tuhay Graciela, Pein María Carolina, Masevicius Fabio Daniel, Kutscherauer Daniela Olmos, Dubin Arnaldo
Primary Institution: Servicio de Terapia Intensiva, Sanatorio Otamendi y Miroli, Buenos Aires, Argentina
Hypothesis
The acidifying effect of severe hyperlactatemia is frequently masked by alkalinizing processes that normalize the base excess.
Conclusion
Critically ill patients may present severe hyperlactatemia with normal values of pH, bicarbonate, and base excess due to associated hypochloremic alkalosis.
Supporting Evidence
- 11% of patients had severe hyperlactatemia.
- 80% of patients with severe hyperlactatemia had low base excess levels.
- Shock was more frequent in the low base excess group (46% vs 24%).
- Chronic obstructive pulmonary disease was more common in the normal base excess group (38% vs 4%).
Takeaway
Some very sick patients can have high levels of lactate in their blood but still show normal acid-base balance because of other factors that balance it out.
Methodology
A prospective observational study evaluating 1,592 patients in an ICU for severe hyperlactatemia.
Limitations
The study is observational and only evaluated patients on ICU admission; serial measurements were not performed.
Participant Demographics
Patients included were critically ill, with a mean age of 63 years, and included both genders.
Statistical Information
P-Value
0.02
Statistical Significance
p<0.05
Digital Object Identifier (DOI)
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