Lactate clearance and metabolic aspects of continuous high-volume hemofiltration

Lactic acidosis is associated with highmorbidity and mortality in hospitalized patients. Treatment of lactic acidosis is targeted on correcting the underlying causes and optimizing adequate oxygen delivery to the tissues. Even though evidence is lacking, continuous renal replacement therapy (CRRT) and dialysis have been advocated as treatments for lactic acidosis. We report a 28-year-old Caucasianmalewith a history of hemophagocytic lymphohistiocytosiswho presentedwith septic shock, severe lactic acidosis andmultiple organ failure. Metabolic acidosiswas corrected after bicarbonate therapy and CRRTwith a hemofiltration rate of 7 L/h (58mL/kg/h). Lactate clearancewas calculated to be 79mL/min. Comparedwith reported rates of lactate overproduction in septic shock, the rate of lactate clearance is quite small. Our case suggests that CRRT with high-volume hemofiltration is not effective for severe lactic acidosis. Lactic acidosis alone should not be considered as a nonrenal indication for CRRT.