Approach to Lactic Acidosis

Info

🌱 來自: Huppert’s Notes

Approach to Lactic Acidosis🚧 施工中

Approach to Lactic Acidosis

•   Description: Elevated serum lactate. Higher serum lactate levels are associated with higher mortality in both shock and nonshock patients

•   Etiologies:

-   Type A lactic acidosis (most common): Systemic tissue hypoperfusion or hypoxemia (e.g., due to sepsis, ischemia)

-   Type B lactic acidosis (less common): Toxin-induced impairment of cellular metabolism and regional areas of ischemia. Ddx:

•   Seizures

•   Decreased gluconeogenesis:

-   Liver disease (decreased lactate clearance)

-   Metformin

•   Increased glycolysis:

-   Albuterol

-   Cocaine

-   Pheochromocytoma

-   Epinephrine

-   Warburg effect: Cancer cells tend to produce energy via glycolysis and then lactic acid fermentation via anaerobic respiration given their high metabolic demands. Can present clinically as hypoglycemia and lactic acidosis in a patient with malignancy.

•   Impaired Krebs’s cycle:

-   Thiamine deficiency

-   Mitochondrial toxicity

•   Alcohol

•   Medications (metformin, propofol, linezolid, NRTIs)

•   Toxins

•   Genetic mitochondrial disorders

•   Treatment:

-   Type A lactic acidosis: Treat underlying cause

-   Type B lactic acidosis: Treat underlying cause if possible, remove offending medication, sometimes no treatment is indicated