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NDT Plus Advance Access originally published online on June 9, 2009
NDT Plus 2009 2(5):408-411; doi:10.1093/ndtplus/sfp065
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© The Author [2009]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Severe hyperlactaemia in the setting of alkalaemia

Andrew M. Hall1 and Michael R. Bending2

1 Centre for Nephrology, University College London
2 South West Thames Renal and Transplantation Unit, St Helier Hospital, UK

Correspondence: Correspondence and offprint requests to: Andrew M. Hall; E-mail: andrew.hall@ucl.ac.uk

Key Words: alcoholic • alkalaemia • hyperlactaemia • metabolic alkalosis

Received for publication April 9, 2009. Accepted for publication May 19, 2009.

The first 150 words of the full text of this article appear below.


   Introduction
 
Alcoholic patients may present with a range of metabolic derangements due to malnutrition, chronic liver disease and renal tubular dysfunction. In the case presented here, we describe a patient in whom the effects of alcohol abuse and complications of previous gastrointestinal surgery combined to cause a number of biochemical abnormalities. The most striking of these were observed in the arterial blood gases, which revealed severe hyperlactaemia (lactate 23 mmol/l) in the setting of significant alkalaemia (pH 7.64); this is a highly unusual finding and in our discussion of the case, we have attempted to explain the possible underlying causes for this. Hyperlactaemia most likely occurred due to a combination of factors including hypoxia, hypovolaemia, vitamin deficiency, increased gastrointestinal production of lactate and impaired removal of lactate by the liver and kidney. Evidence exists to support the concept that an alkalaemic state can significantly potentiate a rise in serum lactate concentration under anaerobic . . . [Full Text of this Article]


   Case history
 

   Discussion
 

   Teaching points
 

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