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BICARBONATE HEMODIALYSIS IN A PATIENT WITH LACTIC ACIDOSIS, SEPSIS, DIC, AND ACUTE RENAL FAILURE

Conventional acetate hemodialysis may exacerbate acidosis in the patient with elevated serum lactate. The patient who is unable to utilize acetate may actually lose serum bicarbonate into the dialysate.Hence bicarbonate rich dialysate (containing 34 mEq/1 bicarbonate) was utilized when a patient with sepsis and acute renal failure developed lactic acidosis with an R fraction of 37 mEq/1. Arterial pH was 7.33 with a pC02 of 15 mm Hg and a base deficit of 17 mEq/1. Three hours of bicarbonate dialysis decreased the R fraction to 17 mEq/1, elevated the pH to 7.38, and lowered the base deficit to 6 mEq/1. The lactate pyruvate ratio fell from 31.1:1 to 16.6:1.Within 48 hours, despite the maintenance of normal blood pressure, the R fraction had risen to 35 mEq/1. The pH had fallen to 7.18 with a base deficit of 19 mEq/1. Three hours of bicarbonate hemodialysis caused lowering of the R fraction and base deficit to 16 mEq/1 and 5 mEq/1 respectivetly with elevation of the pH to 7.33.The correction of the lactate pyruvate ratio and the improvement in acid base balance demonstrated in this patient suggests that bicarbonate hemodialysis may be useful in the therapy of patients with acute renal failure complicated by lactic acidosis.