Lactic acidosis

Background

Clinical Features

Differential Diagnosis

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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
  • 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

Evaluation

  • Hyperlactatemia = Lactate >2 mEq/L
  • Lactic Acidosis = Lactate >4 mEq/L

Lactate False Positives

  • Beta agonists or beta stimulation
  • Extreme exercise
  • Seizures, immediate ictal period
  • Hepatic failure
    • Lactate ringer's solution unlikely to cause false positive except in hepatic failure

Management

  • Treat underlying cause

Disposition

  • Depends on underlying cause

See Also

External Links

References

  1. Dodda V and Spiro P. Albuterol, an Uncommonly Recognized Culprit in Lactic Acidosis. Chest. 2011;140.