lactic acidosis
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Introduction
Also see D-lactic acidosis
Classification
- type A: hypoperfusion, hypoxia
- type B: perfusion & oxygenation adequate
Etiology
- cardiopulmonary arrest
- shock
- pulmonary edema
- severe hypoxemia
- carbon monoxide poisoning
- vascular insufficiency
- mesenteric ischemia
- ischemia of extremity
- anemia
- conditions that cause an increase in metabolic rate
- generalized seizures
- strenous exercise
- severe asthma
- hypothermic shivering
- toxins/drugs (type B)
- cyanide
- salicylates
- ethylene glycol, propylene glycol
- methanol
- nucleoside reverse transcriptase inhibitors
- metformin (Glucophage) with serum creatinine > 1.5 mg/dL
- rare, but 30-50% mortality[2]
- norepinephrine (Levophed)
- propofol (Diprivan)
- linezolid
- metabolism of nitroprusside
- other conditions (type B)
- hematologic malignancy - lymphoma
- diabetes mellitus (generally with DKA)
- hypoglycemia
- D-lactate producing bacteria in short bowel syndrome
- G6PD deficiency
- liver failure
Pathology
- impaired tissue perfusion & oxygenation
- impaired oxidative phosphorylation
- impaired elimination of pyruvate via pyruvate carboxylase
- patients with liver or renal failure are predisposed to lactic acidosis since these are the major organs involved in catabolism of lactate
Laboratory
- plasma lactate* > 4 mg/dL (0.44 mmol/L)[2]
- arterial blood gas: decreased pH
- electrolytes: increased anion gap
- hyperphosphatemia, hyperuricemia, hyperkalemia may occur
- salicylate in serum if respiratory alkalosis with compensatory anion-gap metabolic acidosis (or suspected salicylate tocxicity)[7]
* plasma L-lactate (does not measure D-lactate produced by intestinal bacteria)[2]
Management
- supportive measures
- adequate hydration
- treat underlying condition
- bicarbonate for persistent severe metabolic acidosis (pH < 7.1)[2]
- renal dialysis
More general terms
More specific terms
Additional terms
References
- ↑ Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 59
- ↑ 2.0 2.1 2.2 2.3 2.4 Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 17, 18. American College of Physicians, Philadelphia 2009, 2012, 2015, 2018.
- ↑ Rachoin JS, Weisberg LS, McFadden CB. Treatment of lactic acidosis: appropriate confusion.s;irato J Hosp Med. 2010 Apr;5(4):E1-7 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20394011
- ↑ Kraut JA, Madias NE. Lactic acidosis. N Engl J Med. 2014 Dec 11;371(24):2309-19. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/25494270
Kraut JA, Madias NE. Lactic acidosis. N Engl J Med. 2015 Mar 12;372(11):1078-9. PMID: https://www.ncbi.nlm.nih.gov/pubmed/25760366 Free Article - ↑ Seheult J, Fitzpatrick G, Boran G. Lactic acidosis: an update. Clin Chem Lab Med. 2017 Mar 1;55(3):322-333. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/27522622 Free Article
- ↑ 6.0 6.1 Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
- ↑ 7.0 7.1 NEJM Knowledge+ Endocrinology