Review Question - QID 104300

This patient just had a seizure and is postictal and is demonstrating an arterial blood gas suggestive of an anion gap acidosis. This is likely from an increased lactate from the seizure which should clear on its own spontaneously.

Postictal lactic acidosis is caused by increased lactic acid production in muscle and decreased uptake of lactate by the liver. The increased lactic acid production in muscle is due to the vigorous contraction of muscles that accompanies tonic-clonic seizures. During this contraction, muscle tissue activates anaerobic metabolism because oxygen demand outpaces oxygen supply to the muscle. This results in anaerobic glycolysis which produces lactic acid as a byproduct. Patients who are postictal with a lactic acidosis need to only be observed as their mental status and lactate should normalize on their own.

Incorrect Answers:
Answer 1: Dialysis would be indicated for severe electrolyte abnormalities or an acidosis that will not resolve on its own. This patient's lactate/acid-base status has a known etiology and it will resolve on its own.

Answer 2: Intubation could be indicated for a respiratory acidosis secondary to respiratory failure. This patient is actually hyperventilating appropriately to correct their acid-base status.

Answer 3: Normal saline may help clear a lactic acidosis if it is secondary to poor perfusion and dehydration. This patient's wet mucous membranes and normal dermatologic exam suggest that she is well hydrated and does not need any fluids.

Answer 5: Sodium bicarbonate is generally not the preferred method of treating an abnormal acid-base status. Rather, the underlying etiology should be treated and only severe/refractory cases should be treated with sodium bicarbonate. Sodium bicarbonate might be appropriate for treating hyperkalemia which would present with peaked T waves or QRS widening on ECG.

Bullet Summary:
A lactic acidosis after a seizure is a normal finding and normalizes on its own.