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NDT Plus Advance Access published online on February 5, 2008
NDT Plus, doi:10.1093/ndtplus/sfm054
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© The Author [2008]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Lactate-buffered dialysis in cardiogenic shock associated with severe combined lactic acidosis

Martin Balik1, Petr Waldauf2, Katerina Glocknerova2 and Dagmar Kusova1

1 Department of Anaesthesia and Intensive Care, General Teaching Hospital, U nemocnice 2, Prague 2
2 Department of Anaesthesia and Intensive Care, University Hospital Kralovske Vinohrady, Srobarova 50, Prague 10, Czech Republic

Correspondence: Martin Balik, Department of Anaesthesia and Intensive Care, General Teaching Hospital, U nemocnice 2, Prague 2, 12000, Czech Republic. Tel: +420-224963481; Fax: +420-224962118; E-mail: martin.balik{at}post.cz


  Abstract

The level of lactate that would serve as cut-off for contraindication of lactate buffer is so far unclear. An acute exogenous load of lactate does not affect the basal endogenous lactate production and metabolism. It is also well metabolized in patients suffering from acute renal failure and severe sepsis with a compromised haemodynamic status. We report a case of extreme lactic acidosis in a patient admitted with a combination of cardiogenic shock, uraemia and suspected accumulation of biguanide. The patient was successfully treated with lactate-buffered dialysis due to the accidental absence of the bicarbonate-buffered fluids.

Key Words: haemodiafiltration • intensive care • lactic acidosis • metformin

Received for publication October 22, 2007. Accepted for publication December 28, 2007.


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