Lactic acidosis: Difference between revisions

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Lactic acidosis should be differentiated from:
Lactic acidosis should be differentiated from:


* Any shock state
*Any shock state
* SIRS; lactate may be 2-5 mEq/L
*SIRS; lactate may be 2-5 mEq/L
* Thiamine deficiency
*Thiamine deficiency
* Seizures
*Seizures
* Infarcted colon
*Infarcted colon
* Hepatic failure
*Hepatic failure
* Malignancy
*Malignancy
* Heavy exercise
*Heavy exercise
* Albuterol and other beta agonists
*Albuterol and other beta agonists
* Toxicologic Causes:
*Toxicologic Causes:
** Cyanide
**Cyanide
** Carbon Monoxide
**Carbon Monoxide
** Metformin use in diabetics
**Metformin use in diabetics
** Didanosine
**Didanosine
** Stavudine
**Stavudine
** Zidovudine
**Zidovudine
** Linezolid
**Linezolid
** Strychnine
**Strychnine
** Rotenone (Fish Poison
**Rotenone (Fish Poison
** Phospine (rodenticide)
**Phospine (rodenticide)
** INH (if patient seizes)
**INH (if patient seizes)
** Valproate
**Valproate
** Hydrogen Sulfide
**Hydrogen Sulfide
** Nitroprusside (cyanide)
**Nitroprusside (cyanide)
** Ricin & Castor Beans
**Ricin & Castor Beans
** Propofol
**Propofol
** Sympathomimetics (cocaine, methamphetamine)
**Sympathomimetics (cocaine, methamphetamine)


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<br />
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<br />
<br />
==[[Lactic acidosis natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
==[[Lactic acidosis natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
<br />
Lactic acidosis in critically ill patients is associated with a high mortality rate; it has the highest mortality as compared with other types of acidoses. <br />
==Diagnosis==
==Diagnosis==



Revision as of 12:43, 2 August 2021


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Lactic acidosis
Lactic acid

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Overview

Historical Perspective

Classification

Pathophysiology

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Differentiating Lactic acidosis from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Treatment

Medical Therapy

Primary Prevention

Secondary Prevention

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Case #1

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and keywords: Lactate levels raised (plasma or serum); lactic acidemia; lactic acidaemia.

Overview

Lactic acid is a carbohydrate and its levels rise with increased metabolism during exercise and with catecholamine stimulation. The excess of lactic acid in the body causes muscle pain and serum levels above 4mmol/L and a blood pH ≤7.35, and occurs when oxygen levels in the body drop (hypoxia). The occurrence of LA in type 2 diabetes is of great concern because the mortality rate of LA can be as high as 50%

Historical Perspective

Scherer was the first to record lactic acid in human blood in 1843. Subsequent work by Carl Folwarczny in 1858 built upon the understanding of the condition.

Classification

Lactic acidosis is classified into Type A (hypoxemic) and type B (due to underlying conditions or drugs).

Pathophysiology

A general idea about the development of lactic acidosis is that any mechanisms that increase production of, or decrease clearance of lactate lead to lactic acidosis.

Causes


Differentiating Lactic acidosis from other Diseases

Lactic acidosis should be differentiated from:

  • Any shock state
  • SIRS; lactate may be 2-5 mEq/L
  • Thiamine deficiency
  • Seizures
  • Infarcted colon
  • Hepatic failure
  • Malignancy
  • Heavy exercise
  • Albuterol and other beta agonists
  • Toxicologic Causes:
    • Cyanide
    • Carbon Monoxide
    • Metformin use in diabetics
    • Didanosine
    • Stavudine
    • Zidovudine
    • Linezolid
    • Strychnine
    • Rotenone (Fish Poison
    • Phospine (rodenticide)
    • INH (if patient seizes)
    • Valproate
    • Hydrogen Sulfide
    • Nitroprusside (cyanide)
    • Ricin & Castor Beans
    • Propofol
    • Sympathomimetics (cocaine, methamphetamine)


Epidemiology and Demographics

Lactic acidosis is a rare event, with an estimated incidence of 4.3 cases per 100,000 person-years in metformin users. The occurrence in type 2 diabetes is alarming as the mortality can be up to 50%. A secondary analysis of more than 41,000 person-years in type 2 diabetes showed that the incidence of LA in diabetic patients not exposed to metformin was between 9.7 and 16.7 per 100,000 person-years. Lactic acidosis often occurs in patients with acute severe asthma, most likely due to fatiguing respiratory muscles and subsequent inadequate oxygen delivery to the muscles and liver ischemia. Severe lactic acidosis also occurs in sedated mechanically ventilated patients without respiratory muscle activity.

Risk Factors


Natural History, Complications and Prognosis

Lactic acidosis in critically ill patients is associated with a high mortality rate; it has the highest mortality as compared with other types of acidoses.

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings


Treatment

Medical Therapy | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies


Case Studies

Case #1


Related Chapters


Additional Resources

  • Clinical Physiology of Acid-Base and Electrolyte Disorders by Rose, Post
  • Intensive Care Medicine by Irwin and Rippe
  • The ICU Book by Marino
  • Cohen R, Woods H. Clinical and Biochemical Aspects of Lactic Acidosis. Blackwell Scientific Publications; 1976. ISBN 0-632-09460-5.

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