Clinical Mysteries • Critical Care
The Lactic Acidosis With Normal Pressure
The presentation
Blood pressure appeared acceptable, yet lactate climbed and the patient became mottled and oliguric.
The first explanation was plausible, but the pattern did not fully fit. A deliberate second look focused on physiology, medication/exposure history, serial observations and the clue that the initial diagnosis could not explain.
The turn
Peripheral perfusion and metabolic markers revealed inadequate tissue oxygen delivery.
Diagnosis
Occult shock
Why this case matters
Normal BP does not guarantee normal perfusion.
Take-home message: When the clinical course contradicts the working diagnosis, stop escalating the same treatment and rebuild the problem from first principles.