From the Guidelines
Lactic acidosis is strongly associated with the development of hyperkalemia, as the condition leads to a shift of potassium ions from cells into the bloodstream in an attempt to buffer excess hydrogen ions. This occurs because during lactic acidosis, hydrogen ions accumulate in the bloodstream, causing acidemia. To buffer this excess acid, hydrogen ions move into cells while potassium ions shift out of cells and into the bloodstream, resulting in hyperkalemia. The most recent and highest quality study on this topic is from 2018, which provides guidance on the management of hyperkalemia in patients with cardiovascular disease treated with renin-angiotensin-aldosterone system inhibitors 1. According to this study, hyperkalemia can be classified as mild, moderate, or severe, and the risk of arrhythmic emergencies and sudden arrhythmic death varies widely among patients. Some key points to consider in the management of hyperkalemia include:
- Immediate interventions for severe hyperkalemia, such as calcium gluconate, insulin, and sodium bicarbonate, to stabilize cardiac membranes and shift potassium back into cells 1
- The use of potassium-lowering agents, such as loop diuretics and potassium binders, to manage hyperkalemia 1
- The importance of monitoring potassium levels and renal function closely in patients with hyperkalemia, particularly those on renin-angiotensin-aldosterone system inhibitors 1
- The need to evaluate the patient's diet, use of supplements, and concomitant medications that may contribute to hyperkalemia, and to adjust treatment accordingly 1 In summary, the relationship between lactic acidosis and hyperkalemia is complex, and management of hyperkalemia requires a comprehensive approach that takes into account the underlying cause of the condition, as well as the patient's individual needs and risk factors. It is essential to prioritize the management of hyperkalemia to prevent cardiac arrhythmias and other complications, and to closely monitor electrolytes and acid-base status during treatment 1.
From the FDA Drug Label
Administration of Potassium Chloride in Lactated Ringer’s and 5% Dextrose Injection, USP may result in an iatrogenic increase in serum lactate levels and interfere with interpretation of serum lactate levels in patients with severe metabolic acidosis including lactic acidosis
- The relationship between lactic acidosis and hyperkalemia is that lactic acidosis may be associated with an iatrogenic increase in serum lactate levels when potassium chloride is administered in patients with severe metabolic acidosis, including lactic acidosis.
- However, the direct relationship between lactic acidosis and hyperkalemia is not explicitly stated in the label.
- It is mentioned that hyperkalemia may occur in patients with severe renal impairment, but this is not directly related to lactic acidosis 2
From the Research
Relationship between Lactic Acidosis and Hyperkalemia
- Lactic acidosis and hyperkalemia can be related, as evidenced by a case study where a diabetic patient developed metabolic acidosis characterized by a fairly elevated anion gap, hyperchloremia, severe hyperkalemia, and high plasma levels of lactic acid 3.
- The pathogenesis of metabolic acidosis in this case was attributed to both the increased plasma level of lactic acid and type IV renal tubular acidosis syndrome, with an infection of the urinary tract being the precipitating factor.
- Another study discusses the causes of hyperkalemia, including kidney disease, hyperglycemia, and medication use, but does not specifically address the relationship between lactic acidosis and hyperkalemia 4.
- Lactic acidosis can occur due to various reasons, including medication-induced hyperlactatemia, and can be associated with morbidity and mortality 5.
- In some cases, lactic acidosis can be self-limiting and does not require specific treatment, such as in cases following generalized epileptic attacks 6.
- The relationship between lactic acidosis and hyperkalemia is complex and can be influenced by various factors, including underlying medical conditions, medication use, and the presence of other electrolyte disorders 3, 4.