It is typical for total lactate, acid and base to be combined together and considered a useful parameter. When we consider the term oversimplification and the problem it creates, this is a good example. Lactate and lactic acid are not the same. They have the opposite effect on the level of acidity, that is the pH. Considering total lactate as an independent value or parameter creates a misunderstanding.
It is not productive or enlightening to contrive an indicator of disease with two opposites combined together. Rising total lactate, acid and base together is considered an independent predictor of illnesses such as sepsis. This it may be but this approach does not consider the effect of proliferating the misunderstanding of acid base physiology. Simplistically we do not need to consider the ratio of acid to base, only the total. The cost of oversimplifying the situation is not worth the misunderstanding that this approach creates.
There will always be a ratio of lactic acid to lactate as a base. The more lactic acid predominates the worse the situation is. The total lactate should always be considered with the pH which determines the ratio of lactate to lactic acid. The more lactate is pared with an inert cation such as sodium there is the more pH will go up. The more lactic acid there is the more the pH will go down. The important characteristic is how they affect hydrogen ion concentration, that is pH, each in the opposite direction.
Sometimes explaining a topic so people will understand is only to explain it so people will think they understand. This is what oversimplification is. People believe they understand when they have been mislead. The way lactate is generally explained is not really true but serves an intent. There is a certain product in simplifying a concept so that people think they understand when they actually don’t. This approach is a poor choice.
When lactic acid is produced by anaerobic metabolism the total lactate measured this way generally goes up. We don’t know the effect this has unless we measure the pH. The production of lactic acid produces an acidemia, lower pH. However. lactate is a base. The more lactate there is, the higher the pH should go and the more alkaline the blood would be. The idea that total lactate means acidosis or acidemia is a contradiction of the term lactate. Lactate is a base not an acid. Lactate meaning lactic acid combined with lactate base is is an idea that will and does confuse the unwary.