ABSTRACT

Lactic acidosis is not a disease but an epiphenomenon that occurs in association with a number of serious disorders, which cause considerable morbidity and mortality. The production of lactic acid is not pathological. Rather, it is a vital source of necessary ATP both at its site of production and for distant tissues. Lactic acidosis occurs when an imbalance between the generation and utilization of lactic acid results in an increase in circulating lactate with accompanying bicarbonate consumption. There is no general agreement about the level of hyperlactatemia required to qualify as lactic acidosis, but patients with plasma lactate concentrations of greater than 4 mmol=L usually have a clinically significant metabolic acidosis (1) or a mixed acidbase disorder (see Chapters 9 and 22).