In Reply We agree that sepsis is an important consideration in the initial presentation of a patient with an elevated lactate level, especially in an immunocompromised patient. Delaying treatment for sepsis can have devastating consequences and we appreciate Mr Swenson and Dr Wira putting this aspect into perspective.
Even though antibiotics were not administered to this particular patient, we agree that type B lactic acidosis is a diagnosis of exclusion and that diagnostic tests and therapies for other life-threatening etiologies of lactic acidosis, such as antibiotics for possible sepsis, should not be withheld while a diagnosis is being made.
Chen M, Kim TY, Pessegueiro AM. Cause of an Elevated Lactate Level—Reply. JAMA. 2015;313(23):2381. doi:10.1001/jama.2015.5046