Lactic acidosis: Difference between revisions
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==Background== | ==Background== | ||
*Most common cause of metabolic acidosis in hospitalized patients | *Most common cause of [[metabolic acidosis]] in hospitalized patients | ||
==Clinical Features== | ==Clinical Features== | ||
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*[[Vomiting]] | *[[Vomiting]] | ||
*[[Abdominal pain]] | *[[Abdominal pain]] | ||
*Lethargy | *[[Lethargy]] | ||
*[[Hyperventilation]] | *[[Hyperventilation]] | ||
*[[Hypotension]] | *[[Hypotension]] | ||
| Line 19: | Line 19: | ||
*Lactic Acidosis = Lactate >4 mEq/L | *Lactic Acidosis = Lactate >4 mEq/L | ||
===Lactate False Positives | ===Lactate False Positives=== | ||
*Beta | *[[Beta agonists]] or beta stimulation | ||
*Extreme exercise | *Extreme exercise | ||
*Seizures, immediate ictal period | *[[Seizures]], immediate post-ictal period | ||
*Hepatic failure | *[[Hepatic failure]] | ||
**Lactate ringer's solution unlikely to cause false positive except in hepatic failure | **Lactate ringer's solution unlikely to cause false positive except in hepatic failure<ref>Zitek T, Skaggs ZD, Rahbar A, Patel J, Khan M. Does Intravenous Lactated Ringer's Solution Raise Serum Lactate?. J Emerg Med. 2018;55(3):313-318. doi:10.1016/j.jemermed.2018.05.031</ref><ref>Didwania A, Miller J, Kassel D, Jackson EV Jr, Chernow B. Effect of intravenous lactated Ringer's solution infusion on the circulating lactate concentration: Part 3. Results of a prospective, randomized, double-blind, placebo-controlled trial. Crit Care Med. 1997;25(11):1851-1854. doi:10.1097/00003246-199711000-00024</ref> | ||
==Management== | ==Management== | ||
| Line 34: | Line 34: | ||
==See Also== | ==See Also== | ||
*[[EBQ:Lactate clearance vs central venous oxygen saturation]] | *[[EBQ:Lactate clearance vs central venous oxygen saturation]] | ||
*[[HAART-induced lactic acidosis]] | |||
==External Links== | ==External Links== | ||
Latest revision as of 01:11, 7 March 2021
Background
- Most common cause of metabolic acidosis in hospitalized patients
Clinical Features
Differential Diagnosis
Lactic acidosis
By Type
- Type A (tissue hypoperfusion)
- Type B (decreased utilization)
- Alcoholism
- ↓ Lactate utilization secondary to hepatic dysfunction
- ↓ NAD+/NADH ratio leads to ↑ conversion of pyruvate to lactate
- Metformin
- DKA
- Mainly due to D-lactate production, though hypovolemia contributes
- Liver disease (decreased clearance)
- Adrenergic receptor agonism; viz., albuterol, epinephrine, etc
- Malignancy
- Carbon Monoxide poisoning
- Cyanide poisoning
- Alcoholism
- Type D
- episodes of encephalopathy and metabolic acidosis typically following high carbohydrate meals in patients with short bowel syndrome
- metabolic acidosis and high serum anion gap, normal lactate level, short bowel syn or other forms of malabsorption, and characteristic neurologic findings
- Type D lactate is not detected with standard lactate levels
Complete List
- Any shock state
- SIRS; lactate may be 2-5 mEq/L
- Thiamine deficiency; more often seen in ICU settings; Thiamine is a co-factor for pyruvate dehydrogenase
- Seizure
- Dead gut
- Hepatic failure
- Malignancy
- Exercise
- Albuterol and other beta agonists[1][2]
- Toxicologic Causes:
- Cyanide
- Carbon Monoxide
- Metformin
- Didanosine
- Stavudine
- Zidovudine
- Linezolid
- Strychnine
- Emtriva
- Rotenone (Fish Poison
- NaAzide (Lab Workers)
- APAP (if Liver Fx)
- Phospine (rodenticide)
- NaMonofluoroacetate (Coyote Poison‐ give Etoh as antidote)
- INH (if patient seizes)
- Hemlock
- Valproate
- Hydrogen Sulfide
- Nitroprusside (if cyanide toxic)
- Ricin & Castor Beans
- Propofol
- Sympathomimetics (cocaine, methamphetamine)
- Jequirty peas (Abrus precatorius)
- Prunus Amygdalus plants
- Crab tree apple seeds & cassava (yucca)
- HAART-induced lactic acidosis
Evaluation
- Hyperlactatemia = Lactate >2 mEq/L
- Lactic Acidosis = Lactate >4 mEq/L
Lactate False Positives
- Beta agonists or beta stimulation
- Extreme exercise
- Seizures, immediate post-ictal period
- Hepatic failure
Management
- Treat underlying cause
Disposition
- Depends on underlying cause
See Also
External Links
References
- ↑ Dodda V and Spiro P. Albuterol, an Uncommonly Recognized Culprit in Lactic Acidosis. Chest. 2011;140.
- ↑ . Zitek T, Cleveland N, Rahbar A, et al. Effect of nebulized albuterol on serum lactate and potassium in healthy subjects. Acad Emerg Med 2016;23:718–21.
- ↑ Zitek T, Skaggs ZD, Rahbar A, Patel J, Khan M. Does Intravenous Lactated Ringer's Solution Raise Serum Lactate?. J Emerg Med. 2018;55(3):313-318. doi:10.1016/j.jemermed.2018.05.031
- ↑ Didwania A, Miller J, Kassel D, Jackson EV Jr, Chernow B. Effect of intravenous lactated Ringer's solution infusion on the circulating lactate concentration: Part 3. Results of a prospective, randomized, double-blind, placebo-controlled trial. Crit Care Med. 1997;25(11):1851-1854. doi:10.1097/00003246-199711000-00024