Lactate clearance and metabolic aspects of continuous high-volume hemofiltration

Abstract

Lactic acidosis is associated with high morbidity and mortality in hospitalized patients. Treatment of lactic acidosis is targeted on correcting the underlying causes and optimizing adequate oxygen delivery to the tissues. Even though evidence is lacking, continuous renal replacement therapy (CRRT) and dialysis have been advocated as treatments for lactic acidosis. We report a 28-year-old Caucasian male with a history of hemophagocytic lymphohistiocytosis who presented with septic shock, severe lactic acidosis and multiple organ failure. Metabolic acidosis was corrected after bicarbonate therapy and CRRT with a hemofiltration rate of 7 L/h (58 mL/kg/h). Lactate clearance was calculated to be 79 mL/min. Compared with reported rates of lactate overproduction in septic shock, the rate of lactate clearance is quite small. Our case suggests that CRRT with high-volume hemofiltration is not effective for severe lactic acidosis. Lactic acidosis alone should not be considered as a nonrenal indication for CRRT.

Keywords: continuous renal replacement therapy (CRRT); lactic acidosis; metabolic acidosis.

Fig. 1.

Demonstrated serum lactate and bicarbonate levels during hospitalization; CVVH, continuous venovenous hemofiltration; CVVHD, continuous venovenous hemodialysis; IHD, intermittent hemodialysis.