Lactic acidosis: Difference between revisions
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==Clinical Presentation== | ==Clinical Presentation== | ||
*Anorexia | |||
*Nausea | |||
*Vomiting | |||
*Abdominal pain | |||
*Lethargy | |||
*Hyperventilation | |||
*Hypotension | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
[[File:Elevated Serum Lactate - New Page.jpeg|thumb]] | [[File:Elevated Serum Lactate - New Page.jpeg|thumb]] | ||
===By Type=== | ===By Type=== | ||
*Type A (tissue hypoperfusion) | *'''Type A (tissue hypoperfusion)''' | ||
**Hypovolemia | **Hypovolemia | ||
**Cardiac failure | **Cardiac failure | ||
**[[Sepsis]] | **[[Sepsis]] | ||
*'''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 | |||
**Malignancy | |||
**[[Carbon Monoxide]] poisoning | **[[Carbon Monoxide]] poisoning | ||
**[[Cyanide]] poisoning | **[[Cyanide]] poisoning | ||
===Complete=== | ===Complete=== | ||
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==Diagnosis== | ==Diagnosis== | ||
* | *Hyperlactatemia = Lactate >2 mEq/L | ||
*Lactic Acidosis = Lactate >4 mEq/L | |||
==Management== | ==Management== | ||
Revision as of 13:33, 20 September 2015
Background
- Most common cause of metabolic acidosis in hospitalized patients
Clinical Presentation
- Anorexia
- Nausea
- Vomiting
- Abdominal pain
- Lethargy
- Hyperventilation
- Hypotension
Differential Diagnosis
By Type
- Type A (tissue hypoperfusion)
- Hypovolemia
- Cardiac failure
- Sepsis
- 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
- Malignancy
- Carbon Monoxide poisoning
- Cyanide poisoning
- Alcoholism
Complete
- Any shock state
- Seizure
- Dead gut
- Hepatic failure
- Malignancy
- Exercise
- Use of b‐agonists
- 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
- Depakote
- 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)
Diagnosis
- Hyperlactatemia = Lactate >2 mEq/L
- Lactic Acidosis = Lactate >4 mEq/L
Management
- Treat underlying cause
See Also
Source
- Tintinalli
- EMCrit Podcast Acid-Base