Lactic acidosis during Anesthesia

Abstract

Glucose metabolism is going into two pathways aerobic pathway (kreb's cycle) and anerobic pathway. Biochemistry of lactate involves two types of lactate, l-lactate and d-lactate. Lactate can be used as a fuel for production of energy and lactate production can be increased by interference with any of the pathways that metabolize pyruvate. The clinical significance of lactate shuttle demonstrates its role as a fuel source predominantly in the muscles, heart, brain, and liver, also its role in redox signaling, gene expression and lipolytic control. The acid base balance is concernedwith maintaining a normal hydrogen ion concentration in the body fluids. Types of lactic acidosis are type A, type B which consist of type B1, B2 and B3 lactic acidosis and combined abnormalities (A+B).There is aspecial form of lactic acidosis like D-lactic acidosis. The most Common Etiologies of lactic acidosis are diseases and conditions causing tissue hypoxia, acute severe asthma, acute lung injury, iron deficiency anemia, cardiac Surgery, diabetic ketoacidosis, sepsis, antiretroviral agents, liver failure, malnutrition, alcoholics, cancer. Treatment of lactic acidosis is directed towards correcting the underlying cause of lactic acidosis, antibiotics, surgical methods, hyperventilation, chemotherapy of malignant disorders, optimizing tissue oxygen delivery by cardiopulmonary support, cardiovascular collapse should be treated with fluid replacement and the treatment of the acidosis by sodium bicarbonate with its side effect, isotonic saline infusion, renal replacement therapy, thiamine TRIS/THAM, dichloroacetate and carbicarb.