Lactic acidosis

Background

• Most common cause of metabolic acidosis in hospitalized patients

DDX

• Type A
  • Impaired tissue oxygenation
    • Hypovolemia
    • Cardiac failure
    • Sepsis
    • CO poisoning
    • CN poisoning
• Type B
  • No impaired tissue oxygenation
    • Alcoholism
      • Lactate utilization is impaired 2/2:
        • 1. Impaired hepatic gluconeogenesis
        • 2. No NAD to convert lactate to pyruvate
    • Sepsis
    • Liver disease
    • Metformin

Source

Tintinalli