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Lactic Acidosis in Pulmonary Edema due to Left Ventricular Failure

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Grant support: Grant AM 13698, National Institutes of Health.

▸Requests for reprints should be addressed to Milford Fulop, M.D., Department of Medicine, Bronx Municipal Hospital Center, Pelham Parkway South and Eastchester Road, Bronx, NY 10461.

Bronx, New York

Ann Intern Med. 1973;79(2):180-186. doi:10.7326/0003-4819-79-2-180
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Acidemia is common in severe pulmonary edema due to acute heart failure and is caused by metabolic and respiratory acidosis, in various combinations in different patients. The findings in our study show that the metabolic acidosis is a lactic acidosis. Among 18 patients with acute pulmonary edema due to left ventricular failure, 14 had a blood pH of less than 7.36, and blood lactate concentrations were elevated in most cases (mean, 4.5 millimol/litre ± 2.9 SD). Both the severity of the acidemia and the lowering of the plasma bicarbonate concentration were closely related to the plasma lactate concentration. As pulmonary edema regressed, the lactic acidosis largely abated, within a few hours in most patients, and the blood pH and plasma bicarbonate concentration returned toward normal without the administration of sodium bicarbonate.





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