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Lactic Acidosis

Lactic acidosis is one of the best biomarkers of acute critical illness, its presence should alert the clinician to a major stress response, where medical and surgical and iatrogenic sources should be considered. The magnitude and duration of hyperlactatemia (in the acute phase) is predictive of patient prognosis in critical illness. A sustained high lactate reflects a prolonged stress response. The lactate is not the cause or the problem. It is merely a biomarker. This tutorial looks at the basic biochemistry of lactate production and utilization and makes the point that lactate is produced continuously in the body in vast quantities and is a universal fuel that has medley physiologic functions in the body. I explain the concept of lactic acidosis and the causes. I discuss clearance of lactate and why you need to be careful with your interpretation of what a high lactate means. Plasma lactate level should not be used as an endpoint of resuscitation. I guarantee you’ll learn something. ‪@ccmtutorials‬ www.ccm-tutorials.com Contents 00:15 Introduction 00:43 Review of Previous Tutorial 01:43 Contents of This Tutorial 02:03 The Clinical Importance of Lactate in Critical Care 03:33 Four Clinical Scenarios 05:40 Biochemistry of Lactate 05:55 Why Everything We Were Taught (and continue to be taught( About Lactate is WRONG 07:30 Carbohydrate Metabolism - From Pasta to Lactate and Lactic Acid (pKa 3.8) 09:30 The Metabolic Cycle of Lactate 10:50 We Make Way More Lactate Than You May Think 12:35 Where Does All The Lactate Come From 13:47 The Lactate Shuttle Hypothesis 15:27 The Cori Cycle 16:45 Normal Lactate Homeostasis 18:05 Lactic Acidosis 18:17 "Stress" (hyperadrenergic) Hyperlactatemia 20:52 Hypovolemic Shock (Type A Lactic Acidosis) 22:11 Understanding Lactate "Clearance" in Hypovolemic Shock 23:23 If Lactate Fails to Clear.... 23:35 Other Causes of Persistent Hyperlactatemia (liver disease, late stage sepsis) 24:26 Metformin and Lactic Acidosis 25:00 Traditional "Types" of Lactic Acidosis (Type A, Type B) 25:30 Lactic Acidosis - How to Work the Problem 26:15 The Four Clinical Scenarios - Explained and Resolved 30:35 Causes of Type B Lactic Acidosis 32:!5 Sodium Lactate Solutions - Can they cause lactic acidosis? 33:00 D-Lactate 34:30 Review of the Tutorial and End