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Initial treatment predicates an understanding of basic resuscitation. Airway assessment and stabilization is essential for all patients. Supplemental oxygen may be required, and the airway must be repeatedly reassessed, especially if the patient's mental status or vital signs decline.

An intravenous (IV) line should be established, and fluid repletion with normal saline may be initiated if the patient exhibits tachycardia, hypotension, or other signs of poor tissue perfusion (eg, poor capillary refill, cool extremities). Vital signs and cardiac rhythm must be monitored closely because acidosis predisposes to dysrhythmias including tachydysrhythmias and fibrillation.

Established prehospital treatment protocols should be followed, and nonprotocol medications, such as sodium bicarbonate, should be administered only in conjunction with medical control. Transport all patients to the appropriate emergency facility for further management.

EMERGENCY DEPARTMENT CARE

Lactic acidosis is typically associated with tissue hypoperfusion and states of acute circulatory failure. Treatment of lactic acidosis requires identification of the primary illness and directed therapy.

Restoration of tissue oxygen delivery, thereby causing cessation of acid production, remains the primary therapeutic focus. Goal-directed therapy for sepsis is well described and is associated with improved outcomes. Appropriate measures include treatment of shock, restoration of circulating fluid volume, improved cardiac function, identification of sepsis source and appropriate therapy, and resection of any potential ischemic regions.

CONTINUING CARE

In addition to general supportive measures, treatments must be directed at correction of the underlying disorder and may include the administration of appropriate antibiotics, surgical drainage or debridement, chemotherapy for malignancy, discontinuation of potentially causative medications, and dietary modification in inborn errors of metabolism.

PROCEDURES

Aside from resuscitation measures including adequate intravenous access and airway stabilization in all potentially ill patients, hemoperfusion or hemodialysis may be indicated in association with ethylene glycol and methanol poisoning. Dialysis may also be useful when severe lactic acidosis exists in the setting of renal failure or congestive heart failure and additionally with metformin intoxication.

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13y ago

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