Abstract
BackgroundLactic acidosis is a common cause of high anion gap metabolic acidosis. Sodium bicarbonate may be considered for an arterial pH <7.15 but paradoxically depresses cardiac performance and exacerbates acidosis by enhancing lactate production. This study aimed to evaluate the cause and mortality rate of lactic acidosis and to investigate the effect of factors, including sodium bicarbonate use, on death.MethodsWe conducted a single center analysis from May 2011 through April 2012. We retrospectively analyzed 103 patients with lactic acidosis among 207 patients with metabolic acidosis. We used SOFA and APACHE II as severity scores to estimate illness severity. Multivariate logistic regression analysis and Cox regression analysis models were used to identify factors that affect mortality.ResultsOf the 103 patients with a mean age of 66.1±11.4 years, eighty-three patients (80.6%) died from sepsis (61.4%), hepatic failure, cardiogenic shock and other causes. The percentage of sodium bicarbonate administration (p = 0.006), catecholamine use, ventilator care and male gender were higher in the non-survival group than the survival group. The non-survival group had significantly higher initial and follow-up lactic acid levels, lower initial albumin, higher SOFA scores and APACHE II scores than the survival group. The mortality rate was significantly higher in patients who received sodium bicarbonate. Sodium bicarbonate administration (p = 0.016) was associated with higher mortality. Independent factors that affected mortality were SOFA score (Exp (B) = 1.72, 95% CI = 1.12–2.63, p = 0.013) and sodium bicarbonate administration (Exp (B) = 6.27, 95% CI = 1.10–35.78, p = 0.039).ConclusionsLactic acidosis, which has a high mortality rate, should be evaluated in patients with metabolic acidosis. In addition, sodium bicarbonate should be prescribed with caution in the case of lactic acidosis because sodium bicarbonate administration may affect mortality.
Highlights
Lactic acidosis is defined as hyperlactatemia and metabolic acidosis with increased anion gap
Lactic acidosis, which is caused by the accumulation of lactate, is a common cause of high anion gap metabolic acidosis in severely ill patients in the hospital [1]
The common causes of lactic acidosis are associated with impaired tissue oxygenation due to shock
Summary
Lactic acidosis is defined as hyperlactatemia and metabolic acidosis with increased anion gap. Lactic acidosis, which is caused by the accumulation of lactate, is a common cause of high anion gap metabolic acidosis in severely ill patients in the hospital [1]. The common causes of lactic acidosis are associated with impaired tissue oxygenation due to shock. Vasoconstrictors for increasing blood pressure may worsen tissue perfusion and aggravate lactic acidosis. Lactic acidosis is commonly associated without oxygen deficits, such as toxins, drugs that include metformin, malignancy, hepatic failure, renal failure and diabetes mellitus. Lactic acidosis is a common cause of high anion gap metabolic acidosis. This study aimed to evaluate the cause and mortality rate of lactic acidosis and to investigate the effect of factors, including sodium bicarbonate use, on death
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