Severe perioperative lactic acidosis: How clinically significant is it?
Jerome F. O’Hara, MDAddress reprint requests to J.F.O., Division of Anesthesiology, M26, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195.
John E. Tetzlaff, MD
Michael P. Smith, MD
Lactic acidosis, generally defined as a plasma lactate concentration in excess of 5 mmol/L with a concomitant blood pH less than 7.25, is reported to have a direct association with mortality.OBJECTIVE
To report a case of unexplained perioperative lactic acidosis and to discuss the etiology, recognition, treatment, and importance of a transient rise in plasma lactate concentration.SUMMARY
Severe lactic acidosis developed in a 40-year-old man with Crohn’s disease during major abdominal surgery. The plasma lactate concentration reached 16.9 mmol/L (normal range 1.5 to 2.2 mmol/L). This condition resolved within 14 hours without harm to the patient.CONCLUSIONS
When lactate accumulates in the perioperative period, the responsible condition is most often self-limiting. Reversible, subacute, marked lactic acidosis should not be assumed to predict mortality as it does in patients whose plasma lactate concentrations remain chronically elevated during severe systemic diseases such as sepsis.