Paradoxical increase in arterial hydrogen ion concentration in patients with hepatorenal failure given lactate-based fluids

Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association
A DavenportA M Davison

Abstract

We have investigated lactate intolerance in nine patients with acute hepatorenal failure during 21 machine haemofiltration treatments using a lactate based replacement solution. In all cases hyperlactataemia occurred, the mean arterial lactate increased from 1 +/- 0.2 mmol/l (mean +/- SEM) prior to treatment to 3.2 +/- 0.3 mmol/l at 1 h (P less than 0.01), 4.2 +/- 0.4 mmol/l at 2 h (P less than 0.01), 4.2 +/- 0.4 mmol/l at 3 h (P less than 0.01) and 3.9 +/- 0.4 mmol/l (P less than 0.01) post-treatment. There were correlations between the maximum increase in blood lactate and both the change in arterial hydrogen ion concentration (r = 0.71, P = 0.001) and the mean arterial blood pressure prior to starting treatment (r = -0.57, P = 0.007). During eight of the treatments (38%), the arterial hydrogen ion concentration increased. This group showed increased lactate intolerance in association with a lesser pretreatment mean arterial pressure. The administration of exogenous lactate to patients with hepatorenal failure who are at, or near to, the threshold of their own endogenous lactate metabolism can result in an increase in hydrogen ion concentration rather than the expected decrease, and therefore lactate-based dialysate solutions...Continue Reading

Citations

Nov 24, 1999·Kidney International. Supplement·C SchlaeperN W Levin
Sep 20, 2002·The New England Journal of Medicine·Nguyen Hoan PhuNicholas Day
Jul 1, 1993·Annals of Surgery·B RingeR Pichlmayr
May 12, 2009·Seminars in Dialysis·Andrew Davenport
Oct 17, 2002·Advances in Renal Replacement Therapy·Miet SchetzPatrick T Murray

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