Deleterious hemodynamic effects of severe lactic acidosis are largely suggested by experimental data, although not fully confirmed by human studies. Pending the effectiveness of an etiological treatment, there is no efficient and validated symptomatic therapy at hand to correct a life-threatening metabolic acidosis. Upcoming research in this field should be focused on the optimal strategy to treat severe metabolic acidosis, including symptomatic therapy. Alkalinization with base does not necessarily result in improved cellular or hemodynamic functions and survival rate. Targeting the pH regulatory protein NHE could represent an innovative approach to lactic acidosis management.

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