0
July 24, 1987, Vol 258, No. 4 >
ARTICLE | July 24, 1987

Controversies in Lactic Acidosis: Title and subTitle BreakImplications in Critically III Patients FREE

Barry A. Mizock, MD
[+] Author Affiliations

Reprint requests to Division of Critical Care Medicine, Cook County Hospital, 1835 W Harrison St, Chicago, IL 60612 (Dr Mizock).


JAMA. 1987;258(4):497-501. doi:10.1001/jama.1987.03400040095029
Text Size: A A A
Published online
Article
References

Lactic acidosis is common in critically ill patients and is usually caused by tissue perfusion that is inadequate to meet metabolic demand. However, it has also been noted in conditions in which tissue perfusion is apparently adequate. Hyperlactatemia can occur in the absence of acidosis, usually in the setting of hypermetabolic disease. Numerous areas of controversy exist regarding the pathogenesis of lactic acidosis, as well as certain of its diagnostic, therapeutic, and prognostic features. Knowledge of these areas of controversy should facilitate the clinician's approach to diagnosis and management.

(JAMA 1987;258:497-501)

REFERENCES

1 +
Cannon WB:  Acidosis in shock . Bull Med Paris 1918;;1:424.
2 +
Clausen SW:  Anhydremic acidosis due to lactic acid . AJDC 1925;;29:761-766.
3 +
Cournand A, Riley RL, Bradley SE, et al:  Studies of circulation in clinical shock . Surgery 1943;;13:964-995.
4 +
Huckabee WE:  Abnormal resting blood lactate: I. The significance of hyperlactatemia in hospitalized patients . Am J Med 1961;;30:833-839.
5 +
Cohen RD, Woods HF: Clinical and Biochemical Aspects of Lactic Acidosis . Boston, Blackwell Scientific Publications Inc, 1976;.
6 +
Cohen RD, Woods HF:  Lactic acidosis revisited . Diabetes 1983;;32:181-191.
7 +
Madias NE:  Lactic acidosis . Kidney Int 1986;; 29:752-774.
8 +
Kreisberg RA:  Lactate homeostasis and lactic acidosis . Ann Intern Med 1980;;92:227-237.
9 +
Kreisberg RA:  Pathogenesis and management of lactic acidosis . Annu Rev Med 1984;;35:181-193.
10 +
Park R, Arieff AI:  Lactic acidosis . Adv Intern Med 1980;;25:33-68.
11 +
Harken AH:  Lactic acidosis . Surg Gynecol Obstet 1976;;142:593-606.
12 +
Cohen RD, Iles RA:  Lactic acidosis: Diagnosis and treatment . Clin Endocrinol Metab 1980;;9:513-527.
13 +
Relman AS:  Lactic acidosis , in Brenner BM, Stein JH (eds): Acid-Base and Potassium Homeostasis . New York, Churchill Livingstone, 1978;, pp 65-100.
14 +
Krebs HA, Woods HF, Alberti KGMM:  Hyperlactataemia and lactic acidosis . Essays Med Biochem 1975;;1:81-103.
15 +
Zilva JF:  The origin of the acidosis in hyperlactataemia . Ann Clin Biochem 1978;;15:40-43.
16 +
Tranquada RE, Grant WJ, Peterson CR:  Lactic acidosis . Arch Intern Med 1966;;117:192-202.
17 +
Arieff AI, Park R, Leach W:  Pathogenesis of hypoxic lactic acidosis in dogs . Kidney Int 1982;; 21:143.
18 +
Woods HF, Connor H, Tucker GT:  The role of altered lactate kinetics in the pathogenesis of type B lactic acidosis , in Porter R, Lawrenson G (eds): Metabolic Acidosis . London, Pitman Books Ltd, 1982;, pp 307-323.
19 +
Luft D, Deichsel G, Schmulling R-M, et al:  Definition of clinically relevant lactic acidosis in patients with internal diseases . Am J Clin Pathol 1983;;80:484-489.
20 +
Simmons DH, Alpas AP, Tashkin DT, et al:  Hyperlactataemia due to arterial hypoxemia or reduced cardiac output, or both . J Appl Physiol 1978;;45:195-202.
21 +
Haupt MT, Gilbert EM, Carlson RW:  Fluid loading increases oxygen consumption in septic patients with lactic acidosis . Am Rev Respir Dis 1985;;131:912-916.
22 +
Gilbert EM, Haupt MT, Mandanas RY, et al:  The effect of fluid loading, blood transfusion, and catecholamine infusion on oxygen delivery and consumption in patients with sepsis . Am Rev Respir Dis 1986;;134:873-878.
23 +
Cerra FB: Profiles in Nutritional Managements: The Trauma Patient , monograph. Chicago, Medical Directions, 1982;.
24 +
Siegel JH, Cerra FB, Border JR, et al:  Human response to sepsis: A physiologic manifestation of disordered metabolic control , in Cowley RA, Trump BF (eds): Pathophysiology of Shock, Anoxia and Ischemia . Baltimore, Williams & Wilkins, 1982;, pp 235-253.
25 +
Siegel JH, Cerra FB, Coleman B, et al:  Physiological and metabolic correlations in human sepsis . Surgery 1979;;86:163-193.
26 +
Mizock BA:  Septic shock: A metabolic perspective . Arch Intern Med 1984;;144:579-585.
27 +
Cerra FB:  Metabolic response to injury , in Cerra FB (ed): Manual of Critical Care . St Louis, CV Mosby Co, 1987;, pp 117-145.
28 +
Cerra FB:  Metabolic monitoring: The key to the microcirculation and cellular metabolism , in Shoemaker WC, Thompson WL (eds): Critical Care: State of the Art . Fullerton, Calif, Society of Critical Care Medicine, 1982;, vol 3, pp 1-21.
29 +
Shrago E, Shug A, Elson C:  Regulation of cell metabolism by mitochondrial transport systems , in Hanson RW, Mehlman MA (eds): Gluconeogenesis: Its Regulation in Mammalian Species . New York, John Wiley & Sons Inc, 1976;, pp 221-238.
30 +
Cerra FB:  The role of nutrition in the management of metabolic stress . Crit Care Clin 1986;;2: 807-819.
31 +
Cerra FB:  Metabolic support , in Cerra FB (ed): Manual of Critical Care . St Louis, CV Mosby Co, 1987;, pp 271-325.
32 +
Cerra FB, Border JR, McMenamy RH, et al:  Multiple systems organ failure , in Cowley RA, Trump BF (eds): Pathophysiology of Shock, Anoxia and Ischemia . Baltimore, Williams & Wilkins, 1982;, pp 254-270.
33 +
Ozawa K, Aoyama H, Yasuda K, et al:  Metabolic abnormalities associated with postoperative organ failure . Arch Surg 1983;;118:1245-1251.
34 +
Madoff RD, Fath JJ, Cerra FB:  Metabolic basis of multiple system organ failure . Lancet 1984;;1:514.
35 +
Davies AO, Samuelson WM:  Assessing redox status in human plasma: Experience in critically-ill patients . Crit Care Med 1986;;14:942-946.
36 +
Peitzman A, Pinsky MR, Snyder JV:  Pathophysiology and treatment of septic shock , in Snyder JV, Pinsky MR (eds): Oxygen Transport in the Critically Ill . Chicago, Year Book Medical Publishers Inc, 1987;, pp 419-433.
37 +
Cerra FB:  Cardiovascular responses , in Cerra FB (ed): Manual of Critical Care . St Louis, CV Mosby Co, 1987;, pp 74-89.
38 +
Sibbald WR, Calvin JE, Holliday RL, et al:  Concepts in the pharmacologic and nonpharmacologic support of cardiovascular function in critically-ill surgical patients . Surg Clin North Am 1983;;63:455-482.
39 +
Huckabee WE:  Relationships of pyruvate and lactate during anaerobic metabolism: I. Effects of infusion of pyruvate or glucose and of hyperventilation . J Clin Invest 1958;;37:244-254.
40 +
Jobsis FF, Lamanna JC:  Kinetic aspects of intracellular redox reactions , in Robin ED (ed): Extrapulmonary Manifestations of Respiratory Disease . New York, Marcel Dekker Inc, 1978;, pp 83-85.
41 +
Alberti KGMM, Nattrass M:  Lactic acidosis . Lancet 1977;;2:25-29.
42 +
Davies AO, Samuelson WM:  Nonequilibrium of two redox couplets in human plasma: Lactatepyruvate and beta-hydroxybutyrate-acetoacetate . Crit Care Med 1986;;14:936-941.
43 +
Narins RG, Jones ER, Townsend R, et al:  Metabolic acid-base disorders: Pathophysiology, classification and treatment , in Arieff AI, De Fronzo RA (eds): Fluid, Electrolyte and AcidBase Disorders . New York, Churchill Livingstone Inc, 1985;, pp 301-309.
44 +
Mainwood GW, Worsley-Brown P:  The effect of extracellular pH and buffer concentration on the efflux of lactate from frog sartorius muscle . J Physiol 1975;;250:1-22.
45 +
Spencer TL, Lehninger AL:  L-lactate transport in Ehrlich ascites tumour cells . Biochem J 1976;;154:405-414.
46 +
Halperin ML:  Lactic acidosis and ketoacidosis: Biochemical and clinical implications . Can Med Assoc J 1977;;116:1034-1038.
47 +
Burns HJ, Cowan BN, Ledingham IM:  Metabolic acidosis in the critically-ill , in Porter R, Lawrenson G (eds): Metabolic Acidosis . London, Pitman Books Ltd, 1982;, pp 293-306.
48 +
Iles RA, Barnett D, Strunin L, et al:  The effect of hypoxia on succinate metabolism in man and the isolated perfused dog liver . Clin Sci 1972;;42:35-45.
49 +
Yudkin J, Cohen RD:  The contribution of the kidney to the removal of a lactic acid load under normal and acidotic conditions in the conscious rat . Clin Sci 1975;;48:121-131.
50 +
Mehta K, Kruse JA, Carlson RW:  The relationship between anion gap and elevated lactate . Crit Care Med 1986;;14:404.
51 +
Emmett M, Narins RG:  Clinical use of the anion gap . Medicine 1977;;56:38-54.
52 +
Nanji AA, Campbell DJ, Pudek MR:  Decreased anion gap associated with hypoalbuminemia and polyclonal gammopathy . JAMA 1981;; 246:859-860.
53 +
Halperin ML, Fields ALA:  Lactic acidosis— emphasis on the carbon precursors and buffering of the acid load . Am J Med Sci 1985;;289:154-159.
54 +
Fulop M:  Serum potassium in lactic acidosis and ketoacidosis . NEngl J Med 1979;;300:1087-1089.
55 +
Orringer CE, Eustace JC, Wunsch CD, et al:  Natural history of lactic acidosis after grand-mal seizures . N Engl J Med 1977;;297:769-799.
56 +
Halperin ML, Bear R, Goldstein MB, et al:  Interpretation of the serum potassium concentration in metabolic acidosis . Clin Invest Med 1979;; 2:55-57.
57 +
Cogan MG, Rector FC Jr, Seldin DW:  Acidbase disorders , in Brenner BM, Rector FC Jr (eds): The Kidney . Philadelphia, WB Saunders Co, 1981;, p 863.
58 +
Madias NE, Homer SM, Johns CA, et al:  Hypochloremia as a consequence of anion gap metabolic acidosis . J Lab Clin Med 1984;;104:15-23.
59 +
Stacpoole PW:  Lactic acidosis: The case against bicarbonate therapy . Ann Intern Med 1986;; 105:276-279.
60 +
Weil MH, Rackow EC, Trevino R, et al:  Difference in acid-base state between venous and arterial blood during cardiopulmonary resuscitation . N Engl J Med 1986;;315:153-156.
61 +
Alberti KG, Sestoft L, Cohen RD, et al:  Treatment of metabolic acidosis , in Porter R, Lawrenson G (eds): Metabolic Acidosis . London, Pitman Books Ltd, 1982;, pp 365-371.
62 +
Warner A, Vaziri ND:  Treatment of lactic acidosis . South Med J 1981;;74:841-847.
63 +
Narins RG, Jones ER, Dornfeld LP:  Alkali therapy of the organic acidoses: A critical assessment of the data and the case for judicious use of sodium bicarbonate , in Narins RG (ed): Controversies in Nephrology and Hypertension . New York, Churchill Livingstone Inc, 1984;, pp 359-376.
64 +
Mitchell JH, Wildenthal K, Johnson RL Jr:  The effects of acid-base disturbances on cardiovascular and pulmonary function . Kidney Int 1972;;1: 375-389.
65 +
Yudkin J, Cohen RD, Slack B:  The haemodynamic effects of metabolic acidosis in the rat . Clin Sci 1976;;50:177-184.
66 +
Davies AO:  Rapid desensitization and uncoupling of human beta-adrenergic receptors in an in vitro model of lactic acidosis . J Clin Endocrinol Metab 1984;;59:398-405.
67 +
Narins RG, Cohen JJ:  Bicarbonate therapy for organic acidosis: The case for its continued use . Ann Intern Med 1987;;106:615-618.
68 +
Bellingham AJ, Detter JC, Lenfant C:  Regulator mechanisms of hemoglobin oxygen affinity in acidosis and alkalosis . J Clin Invest 1971;;50:700-706.
69 +
Mattar JA:  Cardiac arrest in the critically ill: Hyperosmolar states following cardiac arrest . Am J Med 1974;;56:162-168.
70 +
Lever E, Jaspan JB:  Sodium bicarbonate therapy in severe diabetic ketoacidosis . Am J Med 1983;;75:263-268.
71 +
Assal JP, Aoki TT, Manzano FM, et al:  Metabolic effects of sodium bicarbonate in management of diabetic ketoacidosis . Diabetes 1974;;23:405-411.
72 +
Fraley DS, Adler S, Fruns FJ, et al:  Stimulation of lactate production by administration of bicarbonate in a patient with a solid neoplasm and lactic acidosis . N Engl J Med 1980;;303:1100-1102.
73 +
Fields ALA, Wolman SL, Halperin ML:  Chronic lactic acidosis in a patient with cancer: Therapy and metabolic consequences . Cancer 1981;; 47:2026-2029.
74 +
Graf H, Leach W, Arieff AI:  Evidence for a detrimental effect of bicarbonate therapy in hypoxic lactic acidosis . Science 1985;;227:754-756.
75 +
Arieff AI, Leach W, Park W, et al:  Systemic effects of NaHCO3 in experimental lactic acidosis in dogs . Am J Physiol 1982;;242:F586-F591.
76 +
Hazard PB, Griffin JP:  Calculation of sodium bicarbonate requirement in metabolic acidosis . Am J Med Sci 1982;;283:18-22.
77 +
Garella S, Dana CL, Chazan JA:  Severity of metabolic acidosis as a determinant of bicarbonate requirements . N Engl J Med 1973;;289:121-126.
78 +
Androgue JH, Brensilver J, Cohen JJ, et al:  Influence of steady-state alterations in acid-base equilibrium on the fate of administered bicarbonate in the dog . J Clin Invest 1983;;71:867-883.
79 +
Yatani A, Funino T, Kinoshita K, et al:  Excess lactate modulates ionic currents and tension components in frog atrial muscle . J Mol Cell Cardiol 1981;;13:147-161.
80 +
Finch CA, Gollnick PD, Hiastala MP, et al:  Lactic acidosis as a result of iron deficiency . J Clin Invest 1979;;64:129-137.
81 +
Jurkowitz M, Scott KM, Altschuld RA, et al:  Ion transport by heart mitochondria: Retention and loss of energy coupling in aged heart mitochondria . Arch Biochem Biophys 1974;;165:98-113.
82 +
Mochiznki S, Kobayashi K, Neely JR:  Effect of D-lactate on glyceraldehyde-3-P dehydrogenase in heart muscle . Recent Adv Stud Cardiac Struct Metab 1978;;12:175-182.
83 +
Peretz DI, Scott HM, Duff J, et al:  The significance of lactic acidemia in the shock syndrome . Ann NY Acad Sci 1965;;119:1133-1141.
84 +
Weil MH, Afifi AA:  Experimental and clinical studies of lactate and pyruvate as indicators of the severity of acute circulatory failure (shock) . Circulation 1970;;41:989-1001.
85 +
Cloutier CT, Lowery BD, Carey LC:  Acid-base disturbances in hemorrhagic shock . Arch Surg 1969;;98:551-557.
86 +
Blair E:  Acid-base balance in bacteremic shock . Arch Intern Med 1971;;127:731-739.
87 +
Schweizer O, Howland WS:  Prognostic significance of high lactate levels . Anesth Analg 1968;; 47:383-388.
88 +
Broder G, Weil MH:  Excess lactate: An index of reversibility of shock in human patients . Science 1964;;143:1457-1459.
89 +
Perret C, Enrico JF:  Lactate in acute circulatory failure , in Bossart H, Perret C (eds): Lactate in Acute Conditions . New York, S Karger AG, 1979;, pp 69-82.
90 +
Rosenberg JC, Rush BF:  Blood lactic acid levels in irreversible hemorrhagic and lethal endotoxic shock . Surg Gynecol Obstet 1968;;126:1247-1250.
91 +
Perret C, Enrico JF:  Lactic acid in shock and liver failure , in Moret PR, Weber J (eds): Lactate: Physiologic, Methodologic and Pathologic Approach . New York, Springer-Verlag NY Inc, 1980;, pp 153-162.
92 +
Cowan BN, Burns HJG, Boyle P, et al:  The relative prognostic value of lactate and haemodynamic measurement in early shock . Anaesthesia 1984;;39:750-755.
93 +
Vitek V, Cowley RA:  Blood lactate in the prognosis of various forms of shock . Ann Surg 1971;;173:308-313.
94 +
Woods WF, Connor H:  The role of liver dysfunction in the genesis of lactic acidosis , in Bossart H, Perret C (eds): Lactate in Acute Conditions . New York, S Karger AG, 1979;, pp 102-114.
95 +
Perret C, Poli S, Enrico JF:  Lactic acidosis and liver damage . Helv Med Acta 1970;;35:377-405.
96 +
Zaidi SAJ, Kruse JA, Carlson RW:  Significance of lactic acidosis in critically ill patients with liver disease . Crit Care Med 1986;;14:404.
97 +
Vincent JL, Dufaye P, Berre J, et al:  Serial lactate determinations during circulatory shock . Crit Care Med 1983;;11:449-451.
98 +
Falk JL, Rackow EC, Leavy J, et al:  Delayed lactate clearance in patients surviving circulatory shock . Acute Care 1985;;11:212-215.
99 +
Snyder JV:  Assessment of systemic oxygen transport , in Snyder JV, Pinsky MR (eds): Oxygen Transport in the Critically Ill . Chicago, Year Book Medical Publishers Inc, 1987;, pp 179-198.
100 +
Carroll G, Snyder J:  Hyperdynamic severe intravascular sepsis depends on fluid administration in cynomolgus monkeys . Am J Physiol 1982;; 243:R131-R141.
101 +
Reuler JB:  Hypothermia: Pathophysiology, clinical settings, and management . Ann Intern Med 1978;;89:519-527.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Cannon WB:  Acidosis in shock . Bull Med Paris 1918;;1:424.
2 +
Clausen SW:  Anhydremic acidosis due to lactic acid . AJDC 1925;;29:761-766.
3 +
Cournand A, Riley RL, Bradley SE, et al:  Studies of circulation in clinical shock . Surgery 1943;;13:964-995.
4 +
Huckabee WE:  Abnormal resting blood lactate: I. The significance of hyperlactatemia in hospitalized patients . Am J Med 1961;;30:833-839.
5 +
Cohen RD, Woods HF: Clinical and Biochemical Aspects of Lactic Acidosis . Boston, Blackwell Scientific Publications Inc, 1976;.
6 +
Cohen RD, Woods HF:  Lactic acidosis revisited . Diabetes 1983;;32:181-191.
7 +
Madias NE:  Lactic acidosis . Kidney Int 1986;; 29:752-774.
8 +
Kreisberg RA:  Lactate homeostasis and lactic acidosis . Ann Intern Med 1980;;92:227-237.
9 +
Kreisberg RA:  Pathogenesis and management of lactic acidosis . Annu Rev Med 1984;;35:181-193.
10 +
Park R, Arieff AI:  Lactic acidosis . Adv Intern Med 1980;;25:33-68.
11 +
Harken AH:  Lactic acidosis . Surg Gynecol Obstet 1976;;142:593-606.
12 +
Cohen RD, Iles RA:  Lactic acidosis: Diagnosis and treatment . Clin Endocrinol Metab 1980;;9:513-527.
13 +
Relman AS:  Lactic acidosis , in Brenner BM, Stein JH (eds): Acid-Base and Potassium Homeostasis . New York, Churchill Livingstone, 1978;, pp 65-100.
14 +
Krebs HA, Woods HF, Alberti KGMM:  Hyperlactataemia and lactic acidosis . Essays Med Biochem 1975;;1:81-103.
15 +
Zilva JF:  The origin of the acidosis in hyperlactataemia . Ann Clin Biochem 1978;;15:40-43.
16 +
Tranquada RE, Grant WJ, Peterson CR:  Lactic acidosis . Arch Intern Med 1966;;117:192-202.
17 +
Arieff AI, Park R, Leach W:  Pathogenesis of hypoxic lactic acidosis in dogs . Kidney Int 1982;; 21:143.
18 +
Woods HF, Connor H, Tucker GT:  The role of altered lactate kinetics in the pathogenesis of type B lactic acidosis , in Porter R, Lawrenson G (eds): Metabolic Acidosis . London, Pitman Books Ltd, 1982;, pp 307-323.
19 +
Luft D, Deichsel G, Schmulling R-M, et al:  Definition of clinically relevant lactic acidosis in patients with internal diseases . Am J Clin Pathol 1983;;80:484-489.
20 +
Simmons DH, Alpas AP, Tashkin DT, et al:  Hyperlactataemia due to arterial hypoxemia or reduced cardiac output, or both . J Appl Physiol 1978;;45:195-202.
21 +
Haupt MT, Gilbert EM, Carlson RW:  Fluid loading increases oxygen consumption in septic patients with lactic acidosis . Am Rev Respir Dis 1985;;131:912-916.
22 +
Gilbert EM, Haupt MT, Mandanas RY, et al:  The effect of fluid loading, blood transfusion, and catecholamine infusion on oxygen delivery and consumption in patients with sepsis . Am Rev Respir Dis 1986;;134:873-878.
23 +
Cerra FB: Profiles in Nutritional Managements: The Trauma Patient , monograph. Chicago, Medical Directions, 1982;.
24 +
Siegel JH, Cerra FB, Border JR, et al:  Human response to sepsis: A physiologic manifestation of disordered metabolic control , in Cowley RA, Trump BF (eds): Pathophysiology of Shock, Anoxia and Ischemia . Baltimore, Williams & Wilkins, 1982;, pp 235-253.
25 +
Siegel JH, Cerra FB, Coleman B, et al:  Physiological and metabolic correlations in human sepsis . Surgery 1979;;86:163-193.
26 +
Mizock BA:  Septic shock: A metabolic perspective . Arch Intern Med 1984;;144:579-585.
27 +
Cerra FB:  Metabolic response to injury , in Cerra FB (ed): Manual of Critical Care . St Louis, CV Mosby Co, 1987;, pp 117-145.
28 +
Cerra FB:  Metabolic monitoring: The key to the microcirculation and cellular metabolism , in Shoemaker WC, Thompson WL (eds): Critical Care: State of the Art . Fullerton, Calif, Society of Critical Care Medicine, 1982;, vol 3, pp 1-21.
29 +
Shrago E, Shug A, Elson C:  Regulation of cell metabolism by mitochondrial transport systems , in Hanson RW, Mehlman MA (eds): Gluconeogenesis: Its Regulation in Mammalian Species . New York, John Wiley & Sons Inc, 1976;, pp 221-238.
30 +
Cerra FB:  The role of nutrition in the management of metabolic stress . Crit Care Clin 1986;;2: 807-819.
31 +
Cerra FB:  Metabolic support , in Cerra FB (ed): Manual of Critical Care . St Louis, CV Mosby Co, 1987;, pp 271-325.
32 +
Cerra FB, Border JR, McMenamy RH, et al:  Multiple systems organ failure , in Cowley RA, Trump BF (eds): Pathophysiology of Shock, Anoxia and Ischemia . Baltimore, Williams & Wilkins, 1982;, pp 254-270.
33 +
Ozawa K, Aoyama H, Yasuda K, et al:  Metabolic abnormalities associated with postoperative organ failure . Arch Surg 1983;;118:1245-1251.
34 +
Madoff RD, Fath JJ, Cerra FB:  Metabolic basis of multiple system organ failure . Lancet 1984;;1:514.
35 +
Davies AO, Samuelson WM:  Assessing redox status in human plasma: Experience in critically-ill patients . Crit Care Med 1986;;14:942-946.
36 +
Peitzman A, Pinsky MR, Snyder JV:  Pathophysiology and treatment of septic shock , in Snyder JV, Pinsky MR (eds): Oxygen Transport in the Critically Ill . Chicago, Year Book Medical Publishers Inc, 1987;, pp 419-433.
37 +
Cerra FB:  Cardiovascular responses , in Cerra FB (ed): Manual of Critical Care . St Louis, CV Mosby Co, 1987;, pp 74-89.
38 +
Sibbald WR, Calvin JE, Holliday RL, et al:  Concepts in the pharmacologic and nonpharmacologic support of cardiovascular function in critically-ill surgical patients . Surg Clin North Am 1983;;63:455-482.
39 +
Huckabee WE:  Relationships of pyruvate and lactate during anaerobic metabolism: I. Effects of infusion of pyruvate or glucose and of hyperventilation . J Clin Invest 1958;;37:244-254.
40 +
Jobsis FF, Lamanna JC:  Kinetic aspects of intracellular redox reactions , in Robin ED (ed): Extrapulmonary Manifestations of Respiratory Disease . New York, Marcel Dekker Inc, 1978;, pp 83-85.
41 +
Alberti KGMM, Nattrass M:  Lactic acidosis . Lancet 1977;;2:25-29.
42 +
Davies AO, Samuelson WM:  Nonequilibrium of two redox couplets in human plasma: Lactatepyruvate and beta-hydroxybutyrate-acetoacetate . Crit Care Med 1986;;14:936-941.
43 +
Narins RG, Jones ER, Townsend R, et al:  Metabolic acid-base disorders: Pathophysiology, classification and treatment , in Arieff AI, De Fronzo RA (eds): Fluid, Electrolyte and AcidBase Disorders . New York, Churchill Livingstone Inc, 1985;, pp 301-309.
44 +
Mainwood GW, Worsley-Brown P:  The effect of extracellular pH and buffer concentration on the efflux of lactate from frog sartorius muscle . J Physiol 1975;;250:1-22.
45 +
Spencer TL, Lehninger AL:  L-lactate transport in Ehrlich ascites tumour cells . Biochem J 1976;;154:405-414.
46 +
Halperin ML:  Lactic acidosis and ketoacidosis: Biochemical and clinical implications . Can Med Assoc J 1977;;116:1034-1038.
47 +
Burns HJ, Cowan BN, Ledingham IM:  Metabolic acidosis in the critically-ill , in Porter R, Lawrenson G (eds): Metabolic Acidosis . London, Pitman Books Ltd, 1982;, pp 293-306.
48 +
Iles RA, Barnett D, Strunin L, et al:  The effect of hypoxia on succinate metabolism in man and the isolated perfused dog liver . Clin Sci 1972;;42:35-45.
49 +
Yudkin J, Cohen RD:  The contribution of the kidney to the removal of a lactic acid load under normal and acidotic conditions in the conscious rat . Clin Sci 1975;;48:121-131.
50 +
Mehta K, Kruse JA, Carlson RW:  The relationship between anion gap and elevated lactate . Crit Care Med 1986;;14:404.
51 +
Emmett M, Narins RG:  Clinical use of the anion gap . Medicine 1977;;56:38-54.
52 +
Nanji AA, Campbell DJ, Pudek MR:  Decreased anion gap associated with hypoalbuminemia and polyclonal gammopathy . JAMA 1981;; 246:859-860.
53 +
Halperin ML, Fields ALA:  Lactic acidosis— emphasis on the carbon precursors and buffering of the acid load . Am J Med Sci 1985;;289:154-159.
54 +
Fulop M:  Serum potassium in lactic acidosis and ketoacidosis . NEngl J Med 1979;;300:1087-1089.
55 +
Orringer CE, Eustace JC, Wunsch CD, et al:  Natural history of lactic acidosis after grand-mal seizures . N Engl J Med 1977;;297:769-799.
56 +
Halperin ML, Bear R, Goldstein MB, et al:  Interpretation of the serum potassium concentration in metabolic acidosis . Clin Invest Med 1979;; 2:55-57.
57 +
Cogan MG, Rector FC Jr, Seldin DW:  Acidbase disorders , in Brenner BM, Rector FC Jr (eds): The Kidney . Philadelphia, WB Saunders Co, 1981;, p 863.
58 +
Madias NE, Homer SM, Johns CA, et al:  Hypochloremia as a consequence of anion gap metabolic acidosis . J Lab Clin Med 1984;;104:15-23.
59 +
Stacpoole PW:  Lactic acidosis: The case against bicarbonate therapy . Ann Intern Med 1986;; 105:276-279.
60 +
Weil MH, Rackow EC, Trevino R, et al:  Difference in acid-base state between venous and arterial blood during cardiopulmonary resuscitation . N Engl J Med 1986;;315:153-156.
61 +
Alberti KG, Sestoft L, Cohen RD, et al:  Treatment of metabolic acidosis , in Porter R, Lawrenson G (eds): Metabolic Acidosis . London, Pitman Books Ltd, 1982;, pp 365-371.
62 +
Warner A, Vaziri ND:  Treatment of lactic acidosis . South Med J 1981;;74:841-847.
63 +
Narins RG, Jones ER, Dornfeld LP:  Alkali therapy of the organic acidoses: A critical assessment of the data and the case for judicious use of sodium bicarbonate , in Narins RG (ed): Controversies in Nephrology and Hypertension . New York, Churchill Livingstone Inc, 1984;, pp 359-376.
64 +
Mitchell JH, Wildenthal K, Johnson RL Jr:  The effects of acid-base disturbances on cardiovascular and pulmonary function . Kidney Int 1972;;1: 375-389.
65 +
Yudkin J, Cohen RD, Slack B:  The haemodynamic effects of metabolic acidosis in the rat . Clin Sci 1976;;50:177-184.
66 +
Davies AO:  Rapid desensitization and uncoupling of human beta-adrenergic receptors in an in vitro model of lactic acidosis . J Clin Endocrinol Metab 1984;;59:398-405.
67 +
Narins RG, Cohen JJ:  Bicarbonate therapy for organic acidosis: The case for its continued use . Ann Intern Med 1987;;106:615-618.
68 +
Bellingham AJ, Detter JC, Lenfant C:  Regulator mechanisms of hemoglobin oxygen affinity in acidosis and alkalosis . J Clin Invest 1971;;50:700-706.
69 +
Mattar JA:  Cardiac arrest in the critically ill: Hyperosmolar states following cardiac arrest . Am J Med 1974;;56:162-168.
70 +
Lever E, Jaspan JB:  Sodium bicarbonate therapy in severe diabetic ketoacidosis . Am J Med 1983;;75:263-268.
71 +
Assal JP, Aoki TT, Manzano FM, et al:  Metabolic effects of sodium bicarbonate in management of diabetic ketoacidosis . Diabetes 1974;;23:405-411.
72 +
Fraley DS, Adler S, Fruns FJ, et al:  Stimulation of lactate production by administration of bicarbonate in a patient with a solid neoplasm and lactic acidosis . N Engl J Med 1980;;303:1100-1102.
73 +
Fields ALA, Wolman SL, Halperin ML:  Chronic lactic acidosis in a patient with cancer: Therapy and metabolic consequences . Cancer 1981;; 47:2026-2029.
74 +
Graf H, Leach W, Arieff AI:  Evidence for a detrimental effect of bicarbonate therapy in hypoxic lactic acidosis . Science 1985;;227:754-756.
75 +
Arieff AI, Leach W, Park W, et al:  Systemic effects of NaHCO3 in experimental lactic acidosis in dogs . Am J Physiol 1982;;242:F586-F591.
76 +
Hazard PB, Griffin JP:  Calculation of sodium bicarbonate requirement in metabolic acidosis . Am J Med Sci 1982;;283:18-22.
77 +
Garella S, Dana CL, Chazan JA:  Severity of metabolic acidosis as a determinant of bicarbonate requirements . N Engl J Med 1973;;289:121-126.
78 +
Androgue JH, Brensilver J, Cohen JJ, et al:  Influence of steady-state alterations in acid-base equilibrium on the fate of administered bicarbonate in the dog . J Clin Invest 1983;;71:867-883.
79 +
Yatani A, Funino T, Kinoshita K, et al:  Excess lactate modulates ionic currents and tension components in frog atrial muscle . J Mol Cell Cardiol 1981;;13:147-161.
80 +
Finch CA, Gollnick PD, Hiastala MP, et al:  Lactic acidosis as a result of iron deficiency . J Clin Invest 1979;;64:129-137.
81 +
Jurkowitz M, Scott KM, Altschuld RA, et al:  Ion transport by heart mitochondria: Retention and loss of energy coupling in aged heart mitochondria . Arch Biochem Biophys 1974;;165:98-113.
82 +
Mochiznki S, Kobayashi K, Neely JR:  Effect of D-lactate on glyceraldehyde-3-P dehydrogenase in heart muscle . Recent Adv Stud Cardiac Struct Metab 1978;;12:175-182.
83 +
Peretz DI, Scott HM, Duff J, et al:  The significance of lactic acidemia in the shock syndrome . Ann NY Acad Sci 1965;;119:1133-1141.
84 +
Weil MH, Afifi AA:  Experimental and clinical studies of lactate and pyruvate as indicators of the severity of acute circulatory failure (shock) . Circulation 1970;;41:989-1001.
85 +
Cloutier CT, Lowery BD, Carey LC:  Acid-base disturbances in hemorrhagic shock . Arch Surg 1969;;98:551-557.
86 +
Blair E:  Acid-base balance in bacteremic shock . Arch Intern Med 1971;;127:731-739.
87 +
Schweizer O, Howland WS:  Prognostic significance of high lactate levels . Anesth Analg 1968;; 47:383-388.
88 +
Broder G, Weil MH:  Excess lactate: An index of reversibility of shock in human patients . Science 1964;;143:1457-1459.
89 +
Perret C, Enrico JF:  Lactate in acute circulatory failure , in Bossart H, Perret C (eds): Lactate in Acute Conditions . New York, S Karger AG, 1979;, pp 69-82.
90 +
Rosenberg JC, Rush BF:  Blood lactic acid levels in irreversible hemorrhagic and lethal endotoxic shock . Surg Gynecol Obstet 1968;;126:1247-1250.
91 +
Perret C, Enrico JF:  Lactic acid in shock and liver failure , in Moret PR, Weber J (eds): Lactate: Physiologic, Methodologic and Pathologic Approach . New York, Springer-Verlag NY Inc, 1980;, pp 153-162.
92 +
Cowan BN, Burns HJG, Boyle P, et al:  The relative prognostic value of lactate and haemodynamic measurement in early shock . Anaesthesia 1984;;39:750-755.
93 +
Vitek V, Cowley RA:  Blood lactate in the prognosis of various forms of shock . Ann Surg 1971;;173:308-313.
94 +
Woods WF, Connor H:  The role of liver dysfunction in the genesis of lactic acidosis , in Bossart H, Perret C (eds): Lactate in Acute Conditions . New York, S Karger AG, 1979;, pp 102-114.
95 +
Perret C, Poli S, Enrico JF:  Lactic acidosis and liver damage . Helv Med Acta 1970;;35:377-405.
96 +
Zaidi SAJ, Kruse JA, Carlson RW:  Significance of lactic acidosis in critically ill patients with liver disease . Crit Care Med 1986;;14:404.
97 +
Vincent JL, Dufaye P, Berre J, et al:  Serial lactate determinations during circulatory shock . Crit Care Med 1983;;11:449-451.
98 +
Falk JL, Rackow EC, Leavy J, et al:  Delayed lactate clearance in patients surviving circulatory shock . Acute Care 1985;;11:212-215.
99 +
Snyder JV:  Assessment of systemic oxygen transport , in Snyder JV, Pinsky MR (eds): Oxygen Transport in the Critically Ill . Chicago, Year Book Medical Publishers Inc, 1987;, pp 179-198.
100 +
Carroll G, Snyder J:  Hyperdynamic severe intravascular sepsis depends on fluid administration in cynomolgus monkeys . Am J Physiol 1982;; 243:R131-R141.
101 +
Reuler JB:  Hypothermia: Pathophysiology, clinical settings, and management . Ann Intern Med 1978;;89:519-527.

Letters

Submit a Letter
CME Course for:


You need to register in order to view this quiz.


To understand the clinical management of acute heart failure syndromes.
Accreditation Information The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
To view and print your certificate and access a summary of your CME courses go to My CME.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Compression-Only CPR: Pushing the Science Forward
Cone
AAM 2010;304:1493-1495.
All you need to read in the other general journals
BMJ 2010;341:c5893-c1494.
Submit a Response

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

© 2012 American Medical Association. All Rights Reserved.
Powered bySilverchair Information Systems