75: Lactic Acidosis in the PICU

Aug 27, 2023

Pediatric ICU physicians discuss lactic acidosis in a 4-year-old boy with hypotension, fatigue, and respiratory distress. They explore the causes, types, and management of lactic acidosis in the PICU. The use of blood lactate levels as markers, the phenomenon of lactic acid washout, and the controversy surrounding bicarbonate therapy are also discussed.

Ask episode

Chapters

Transcript

Episode notes

Introduction

00:00 • 3min

Lactic Acidosis and its Management

02:43 • 13min

Understanding Lactic Acidosis in the PICU

15:20 • 6min

Management and Exogenous Bicarbonate Therapy for Lactic Acidosis

21:00 • 4min

Lactic Acidosis: Bicarbonate Therapy and Lactated Ringers

24:39 • 3min

In this episode of PICU Doc On Call, your hosts Pradip Kamat and Rahul Damania, experienced Pediatric ICU physicians, take you on an enlightening journey through the intricate landscape of lactic acidosis. Join us as we unravel the complexities, share clinical insights, and provide practical guidance on diagnosing and managing this critical condition in the acute care pediatric setting.

You will hear:

Case Presentation:

4-year-old boy with hypotension, fatigue, rash, and respiratory distress

Recent COVID-19 exposure, concerning respiratory symptoms

Hypotensive, tachycardic, tachypneic, low pulse oximetry reading

Swollen red lips, erythematous rash, hepatomegaly

High-flow nasal cannula, resuscitation, epinephrine infusion

Initial arterial blood gas: pH 7.22, lactate 4.5 mMol/L

Definition of Lactic Acidosis:

Hyperlactatemia and lactic acidosis criteria
Causes: impaired tissue oxygenation or mitochondrial dysfunction

Types of Lactic Acidosis:

Type A: Impaired O2 delivery, shock-related
Type B: Impaired O2 utilization, toxins, infections

Lactate Measurement:

Comparability between POCT and central lab analysis
Role of lactate measurement in pediatric sepsis

Lactic Washout:

Rising lactate with re-established oxygen delivery
Impaired clearance in microcirculation, liver, kidney
Monitoring trends with clinical exams and lab surrogates

Bicarbonate Therapy:

Role in Type A lactic acidosis
Controversy, indications, and potential complications

Conclusion:

PICU Doc On Call podcast explores the intriguing case of a 4-year-old boy with lactic acidosis, highlighting the clinical intricacies of diagnosing and managing this condition. The hosts, Pradip Kamat and Rahul Damania provide insightful discussions on the different types of lactic acidosis, the physiological mechanisms behind it, and the role of bicarbonate therapy. The episode emphasizes the importance of addressing underlying causes and offers valuable clinical pearls for managing pediatric patients with lactic acidosis.

Stay tuned for more engaging episodes from PICU Doc On Call! Don't forget to subscribe, share your feedback, and review the podcast on your preferred platform. For more information and resources, visit picudoconcall.org.