Lactic alkalosis is believed to result from proton-coupled lactate export via monocarboxylate transporters (MCT1), and enhanced glycolysis in erythrocytes due to pH-stimulated phosphofructokinase activity. Prior reports describe hyperlactatemia in patients with an acute respiratory alkalosis. This case adds novel ECMO-specific considerations: aggressive CO2 clearance may rapidly shift pH and influence lactate kinetics ex vivo. To our knowledge, this is the first reported instance of lactic alkalosis temporally linked to ECMO sweep gas manipulation, highlighting a unique and benign biochemical artifact.
Carroll et al. (Wed,) studied this question.
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