Lactic Acidosis
Lactic acidosis is one of the most common causes of high SAG metabolic acidosis and can impact
approximately 1% of hospitalized patients. Lactic acid is the end product of anaerobic metabolism of glucose
(glycolysis).7 In normal individuals, lactic acid derived from pyruvate enters the circulation in small amounts
and is promptly removed by the liver. In the liver, and to a lesser extent in the kidney, lactic acid is reoxidized
to pyruvic acid, which is then metabolized to CO2 and H2O. The normal plasma lactate concentration in
healthy subjects is approximately 1 mEq/L (1 mmol/L).3,7,12 The diagnosis of lactic acidosis should be
considered in all patients with metabolic acidosis associated with an increased SAG. Lactic acidosis is
considered to be present when lactate concentrations exceed 4 to 5 mEq/L (4 to 5 mmol/L) in an acidemic
patient.