Figure 4.

Changes in the concentration of lactate, bicarbonate (HCO₃), base excess (BE) and chloride (Cl) after a patient with septic shock was placed on high-volume hemofiltration (HVHF) and received an infusion of 240 mmol/hour lactate. The acidifying effect of hyperlactatemia (fall in bicarbonate and in base excess) was markedly attenuated by a decrease in serum chloride concentration (chloride shift). At the end of 8 hours of HVHF, there was a rebound alkalosis.