From the Guidelines
Liver failure can indeed cause lactic acidosis due to the liver's compromised ability to clear lactate from the bloodstream, as evidenced by the impaired hepatic glucose production and lactate clearance in acute liver failure 1. This occurs because the liver plays a crucial role in metabolizing lactate, and when liver function is impaired, lactate accumulates, leading to lactic acidosis. Management of lactic acidosis in liver failure focuses on treating the underlying liver dysfunction while providing supportive care, including:
- Addressing the cause of liver failure
- Maintaining adequate tissue perfusion with intravenous fluids
- Ensuring proper oxygenation
- Correcting electrolyte imbalances In severe cases, continuous renal replacement therapy (CRRT) may be used to help clear lactate, with bicarbonate preferred as a buffer in patients with lactic acidosis and/or liver failure 1. Additionally, sodium bicarbonate administration is controversial and generally reserved for severe acidosis (pH < 7.1), and thiamine supplementation (100 mg IV daily for 3-5 days) is often recommended as thiamine deficiency can worsen lactic acidosis. Avoiding medications metabolized by the liver that may further impair function is crucial, and the prognosis depends on the severity of liver dysfunction and whether the underlying cause can be effectively treated. In cases of acute liver failure with severe lactic acidosis, liver transplantation may be the definitive treatment if the patient is eligible.
From the Research
Liver Failure and Lactic Acidosis
- Liver failure can contribute to the development of lactic acidosis, as the liver plays a crucial role in removing lactate and hydrogen ions from the body 2, 3.
- The liver's ability to dispose of lactic acid is impaired in liver failure, leading to an accumulation of lactate in the blood 3, 4.
- Lactic acidosis is a serious condition that can have high mortality rates, and prompt recognition and treatment of the underlying causes are essential 2, 5.
Management of Lactic Acidosis in Liver Failure
- The management of lactic acidosis in liver failure involves addressing the underlying cause of the condition, ensuring adequate oxygen delivery to tissues, and reducing oxygen demand 2, 5.
- The use of sodium bicarbonate to treat lactic acidosis is controversial, and its effectiveness is not supported by evidence 5.
- Bicarbonate-buffered solutions may be preferred over lactate-buffered solutions in patients with severe liver failure or lactic acidosis, as lactate can exacerbate the condition 6.
- Targeting lactate production, regulating lactate transport, and modulating lactylation may be potential treatment approaches for liver disease, including liver failure 4.