From the Research
Lactic acidosis following a seizure typically results in blood lactate levels of 2-6 mmol/L, though levels can occasionally rise above 10 mmol/L in severe cases. This elevation occurs because during a seizure, intense muscle activity increases oxygen demand while simultaneously reducing oxygen delivery, forcing muscles to shift to anaerobic metabolism which produces lactic acid 1. The lactate level usually peaks within 30 minutes after the seizure and normalizes within 1-2 hours in most patients.
Key Points to Consider
- Persistent elevation beyond this timeframe may indicate ongoing seizure activity, status epilepticus, or another underlying medical condition 1.
- Clinicians should be aware that post-ictal lactic acidosis is generally transient and self-resolving, requiring no specific treatment beyond supportive care and addressing the underlying seizure disorder 2.
- However, severe acidosis may occasionally require temporary respiratory support or, rarely, bicarbonate administration in extreme cases.
- Elevated lactate levels more than 6 hours after the seizure event may indicate ongoing epileptic activity 1.
Clinical Implications
- The level of lactic acidosis after a seizure can be significant, but it is usually self-limiting and does not require specific treatment 3.
- Repeating an arterial blood sample a few hours later can help determine if the lactic acidosis is resolving or if there is an underlying condition that needs to be addressed 2.
- Clinicians should consider the clinical presentation and laboratory results when evaluating a patient with lactic acidosis after a seizure, and be aware of the potential for ongoing seizure activity or other underlying conditions 1.