Template:Lactic acidosis DDX: Difference between revisions
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====By Type==== | ====By Type==== | ||
*'''Type A (tissue hypoperfusion)''' | *'''Type A (tissue hypoperfusion)''' | ||
**Hypovolemia | **[[Hypovolemia]] | ||
**Cardiac failure | **[[heart failure|Cardiac failure]] | ||
**[[Sepsis]] | **[[Sepsis]] | ||
*'''Type B (decreased utilization)''' | *'''Type B (decreased utilization)''' | ||
**Alcoholism | **[[alcohol Abuse|Alcoholism]] | ||
***↓ Lactate utilization secondary to hepatic dysfunction | ***↓ Lactate utilization secondary to hepatic dysfunction | ||
***↓ NAD+/NADH ratio leads to ↑ conversion of pyruvate to lactate | ***↓ NAD+/NADH ratio leads to ↑ conversion of pyruvate to lactate | ||
**[[Metformin]] | **[[Metformin]] | ||
**DKA | **[[DKA]] | ||
***Mainly due to D-lactate production, though hypovolemia contributes | ***Mainly due to D-lactate production, though hypovolemia contributes | ||
**Liver disease (decreased clearance) | **[[hepatic failure|Liver disease]] (decreased clearance) | ||
**Adrenergic receptor agonism; viz., albuterol, epinephrine, etc | **Adrenergic receptor agonism; viz., [[albuterol]], [[epinephrine]], etc | ||
**Malignancy | **Malignancy | ||
**[[Carbon Monoxide]] poisoning | **[[Carbon Monoxide]] poisoning | ||
| Line 23: | Line 23: | ||
====Complete List==== | ====Complete List==== | ||
*Any shock state | *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]] | *[[Seizure]] | ||
*Dead gut | *[[ischemic bowel|Dead gut]] | ||
*Hepatic failure | *[[Hepatic failure]] | ||
*Malignancy | *Malignancy | ||
*Exercise | *Exercise | ||
*[[Albuterol]] and other beta agonists<ref>Dodda V and Spiro P. Albuterol, an Uncommonly Recognized Culprit in Lactic Acidosis. Chest. 2011;140.</ref> | *[[Albuterol]] and other beta agonists<ref>Dodda V and Spiro P. Albuterol, an Uncommonly Recognized Culprit in Lactic Acidosis. Chest. 2011;140.</ref><ref>. 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.</ref> | |||
*Toxicologic Causes: | *Toxicologic Causes: | ||
**[[Cyanide]] | **[[Cyanide]] | ||
| Line 37: | Line 41: | ||
**Stavudine | **Stavudine | ||
**Zidovudine | **Zidovudine | ||
**Linezolid | **[[Linezolid]] | ||
**Strychnine | **[[Strychnine]] | ||
**Emtriva | **Emtriva | ||
**Rotenone (Fish Poison | **Rotenone (Fish Poison | ||
**NaAzide (Lab Workers) | **NaAzide (Lab Workers) | ||
**APAP (if Liver Fx) | **[[APAP]] (if Liver Fx) | ||
**Phospine (rodenticide) | **Phospine (rodenticide) | ||
**NaMonofluoroacetate (Coyote Poison‐ give Etoh as antidote) | **NaMonofluoroacetate (Coyote Poison‐ give Etoh as antidote) | ||
** | **[[INH]] (if patient seizes) | ||
**Hemlock | **Hemlock | ||
** | **[[Valproate]] | ||
**[[Hydrogen Sulfide]] | **[[Hydrogen Sulfide]] | ||
**Nitroprusside (if cyanide toxic) | **[[Nitroprusside]] (if cyanide toxic) | ||
**[[Ricin]] & Castor Beans | **[[Ricin]] & Castor Beans | ||
**[[Propofol]] | **[[Propofol]] | ||
**Sympathomimetics (cocaine, methamphetamine) | **[[Sympathomimetics]] (cocaine, methamphetamine) | ||
**Jequirty peas (Abrus precatorius) | **Jequirty peas (Abrus precatorius) | ||
**Prunus Amygdalus plants | **Prunus Amygdalus plants | ||
**Crab tree apple seeds & cassava (yucca) | **Crab tree apple seeds & cassava (yucca) | ||
**[[HAART-induced lactic acidosis]] | **[[HAART-induced lactic acidosis]] | ||
Latest revision as of 01:15, 7 March 2021
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