STRATEGIES FOR MANAGING BLOOD ACIDOSIS (DCA) IN THE HOSPITAL: DIAGNOSIS, TREATMENT, AND MONITORING

Abstract

Metabolic acidosis, a condition characterized by an imbalance in acid-base homeostasis, presents significant challenges in hospital settings, particularly in critically ill patients. Dichloroacetate (DCA), a pyruvate dehydrogenase activator, has emerged as a promising therapeutic strategy for managing lactic acidosis, a common form of metabolic acidosis associated with increased lactate production and impaired clearance. This review outlines current strategies for diagnosing, treating, and monitoring blood acidosis, with a focus on the role of DCA. Accurate and rapid diagnosis relies on arterial blood gas analysis, serum lactate measurement, and assessment of underlying etiologies, including sepsis, renal failure, and hypoperfusion. Initial treatment prioritizes addressing the root cause, restoring hemodynamic stability, and buffering severe acidosis with agents like sodium bicarbonate when indicated. DCA's mechanism of action promotes mitochondrial pyruvate oxidation, thereby reducing lactate accumulation and improving cellular energy efficiency. Clinical studies suggest DCA's efficacy in lowering lactate levels, improving hemodynamics, and potentially reducing mortality, although its application is limited by adverse effects, including neuropathy at high doses. Monitoring therapy involves serial blood gas analyses, lactate trending, and assessing organ function to guide ongoing management. This study emphasizes the importance of integrating DCA into a multidisciplinary approach tailored to individual patient needs while addressing gaps in study to optimize its clinical utility.