Lactic acidosis after resuscitation with sodium acetate

Background: At our institution, we began using sodium acetate for resuscitation of trauma patients in 2005. Sodium acetate is used as an alternative to normal saline to help prevent hyperchloremic metabolic acidosis as well as to help buffer metabolic acidosis. Discussion: Here we present a case of a 29-year-old trauma patient who began to have severe lactic acidosis after the infusion of sodium acetate. This is the first reported case of lactic acidosis caused by sodium acetate infusion. Up to this point, we have not experienced any adverse events and patients have tolerated sodium acetate well. Conclusion: This unique case report presents the first case of lactic acidosis from sodium acetate infusion. The lactic acidosis seen in this patient reminds us of the complex regulation of pyruvate dehydrogenase and the potential for down regulation of the enzyme shunting substrates to formation of lactate.