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Abstract
L-lactic acidosis (L-LA) is the most common cause of metabolic acidosis in the critical
care setting, which has been associated with a large increase in mortality. The purpose
of this article is to provide clinicians with an overview of the biochemical and metabolic
background required to understand the different pathophysiological mechanisms that
may lead to the development of L-LA. We propose a classification based on whether
the pathophysiology of L-LA is due predominantly to increased production or decreased
removal of L-lactic acid. In this article, we provide an overview of the biochemical
and metabolic aspects of glucose oxidation, the production and removal of L-lactic
acid, and a discussion of the pathophysiology of the various causes of L-LA.