Abstract

Perioperative lactic acidosis following major surgeries is usually attributed to oxygen debt resulting from tissue hypoxia. Lactate metabolism is more complex than initially appreciated and peri-operative physicians should recognize that causes of hyperlactatemia are myriad, and treatment can be highly disparate. We present a case of severe lactic acidosis which developed in a 67-year-old diabetic man during posterior cervical spine fixation surgery. The plasma lactate level peaked to 16 mmol/L, was fluid and vasopressor unresponsive, with negative urinary ketones, and progressively resolved within 24 hours without significant patient morbidity. This report emphasizes the importance of evaluating elevated lactic acid thoughtfully coupled with the entire clinical picture, and not as mere isolated biomarker of shock induced low flow state.