With great interest, we read the Clinical Focus Review on lactate by Pino and Singh. We strongly agree with the need to decouple an increased lactate level from the mandatory use of fluid infusions.

The authors argue, however, that lactate is a consequence rather than a cause of cellular acidosis and describe the lactate ion as a weak base (“that accepts some of the protons”). This latter statement would imply that increasing lactate levels per se would act to decrease acidity, which is in obvious conflict with ubiquitous clinical experience. In this context, we find the quantitative acid–base perspective as described by Stewart and others theoretically more satisfying and clinically useful. The core of the theory states that the concentration of protons (being weak ions) does not change primarily by processes adding or removing these ions...

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