Lactic Acidosis
last authored: Sept 2010, David LaPierre
last reviewed:
Introduction
The Case of...
a simple case introducing clincial presentation and calling for a differential diagnosis to get students thinking.
Causes and Risk Factors
Elevated lactate can occur due to a number of processes.
Increased lactate production in tissues can occur with:
decreased oxygen transport
increased metabolism
decreased oxygen use
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decreased lactate metabolism
others
enzyme defects
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Pathophysiology
Lactic acid, or lactate, is a byproduct of glycolysis, originating from pyruvate in anaerobic conditions. As oxygen levels fall, lactate levels increase and lead to a metabolic acidosis. Lactate is normally metabolized by the liver. As liver function decreases, lactate levels increase.
Signs and Symptoms
- history
- physical exam
History
Physical Exam
Investigations
- lab investigations
- diagnostic imaging
Lab Investigations
Lab investigations to be done in settings of suspected lactic acidosis include:
- CBC and differential
- electrolytes
- glucose
- renal function tests
- liver enzymes
- osmolality
- arterial blood gases
microbiology should include:
- blood and urine cultures
Diagnostic Imaging
imaging should include:
- chest X-ray
- abdominal X-ray
Differential Diagnosis
The differential diagnosis of acidosis includes:
- respiratory acidosis
Treatments
Management must initially focus on the ABC's in order to maintain stability. This should include:
- oxygen to maintain saturation above 94%
- sufficient IV access
- bicarbonate bolus if pH is severely low
Treat the underlying cause of lactic acidosis as soon as possible.
Consequences and Course
Resources and References
Topic Development
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