Severe perioperative lactic acidosis: how clinically significant is it?
BACKGROUND
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.


CONCLUSIONS
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.
O'Hara
J F
JF
Department of General Anesthesiology, Cleveland Clinic Foundation, OH 44195.
Tetzlaff
J E
JE
Smith
M P
MP
D000140:Acidosis, Lactic / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D000328:Adult; D003424:Crohn Disease / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D007773:Lactates / Q000097:blood; D019344:Lactic Acid; D008297:Male; D012720:Severity of Illness Index
D007773:Lactates; D019344:Lactic Acid