Treatment depends on both the cause and the severity of lactic acidosis (Berndt 2015).
This is particularly common in alcoholics and malnourished people. If a B1 deficiency is detected, the slow i.v. administration of thiamine is recommended (Berndt 2015).
In this case, the elimination of the substance should be carried out by dialysis. This not only removes the metformin from the body, but at the same time bicarbonate is added without sodium or volume load (Berndt 2015).
- Bicarbonate administration:
In lactic acidotic coma, the production of lactate is so pronounced that the acidosis can no longer be compensated by alkali substitution, as the sodium load would then be too high.
However, a pH of at least > 7.1 should be aimed for. The increasing sodium concentration can then be stimulated with diuretics (Hien 2007).
Another problem is the CO2 produced by buffering with bicarbonate, which can only be eliminated by increasing alveolar ventilation. The infusion should therefore be slow. Otherwise, elimination is not guaranteed and the CO2 level in the blood may increase, since the diffusion of CO2 through the cell membrane on the one hand increases intracellular acidosis and on the other hand influences cellular metabolism.
Therefore, buffer substances that do not lead to an increased formation of CO2 such as sodium carbonate, sodium hydrogen carbonate or tris (hydroxymethyl)-aminomethane (TRIS) are discussed
(Berndt 2015).
The massive losses of potassium that occur due to diuresis and acidosis must also be compensated for. This can best be done by hemodialysis. This should be carried out from a
pH < 7.0 and lactate values > 90 mmol / l (Hien 2007).
- Other indications for hemodialysis are:
- Biguanide-induced lactic acidosis (see above)
- hypothermia
- oliguria / anuria
- azotemia
(Berndt 2015)