Lactic acidosis: Difference between revisions

Revision as of 23:45, 4 May 2015

Background

Most common cause of metabolic acidosis in hospitalized patients

Differential Diagnosis

By Type

Type A
- Impaired tissue oxygenation
  - Hypovolemia
  - Cardiac failure
  - Sepsis
  - Carbon Monoxide poisoning
  - Cyanide poisoning
Type B
- No impaired tissue oxygenation
  - Alcoholism
    - Lactate utilization is impaired 2/2:
      - Impaired hepatic gluconeogenesis
      - No NAD+ to convert lactate to pyruvate
  - Sepsis
  - Liver disease
  - Metformin

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)

Source

Tintinalli
EMCrit Podcast Acid-Base

Authors:

@@ Line 2: / Line 2: @@
 *Most common cause of metabolic acidosis in hospitalized patients
-==DDX by Type==
+==Differential Diagnosis==
+===By Type===
 *Type A
 **Impaired tissue oxygenation
@@ Line 14: / Line 15: @@
 ***Alcoholism
 ****Lactate utilization is impaired 2/2:
-*****1. Impaired hepatic gluconeogenesis
+*****Impaired hepatic gluconeogenesis
-*****2. No NAD+ to convert lactate to pyruvate
+*****No NAD+ to convert lactate to pyruvate
 ***[[Sepsis]]
 ***Liver disease
 ***Metformin
-==DDX Complete==
+===Complete===
-#Any shock state
+*Any shock state
-#[[Seizure]]
+*[[Seizure]]
-#Dead gut
+*Dead gut
-#Hepatic failure
+*Hepatic failure
-#Malignancy
+*Malignancy
-#Exercise
+*Exercise
-#Use of b‐agonists
+*Use of b‐agonists
-#Toxicologic Causes:
+*Toxicologic Causes:
-##[[Cyanide]]
+**[[Cyanide]]
-##[[Carbon Monoxide]]
+**[[Carbon Monoxide]]
-##Metformin
+**Metformin
-##Didanosine
+**Didanosine
-##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)
+**Inh (if patient seizes)
-##Hemlock
+**Hemlock
-##Depakote
+**Depakote
-##[[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)
 ==Source==