Lactic acidosis

Classification

• Type A: clinical evidence of impaired tissue oxygenation
  • Anaerobic muscle activity (increased oxygen demand)
    • Heavy exercise
    • Seizures
  • Tissue hypoperfusion (decreased oxygen delivery)
    • Shock
    • Cardiac arrest
    • Regional ischemia (e.g. mesenteric ischemia)
  • Tissue hypoia (decreased available oxygen or oxygen-carrying capacity)
    • Pulmonary hypoxia
    • Carbon monoxide
    • Severe anemia
• Type B: No clinical evidence of impaired tissue oxygenation
  • Type B1: Underlying disease
    • Renal failure
    • Liver failure (post-cellular)
    • Malignancy
    • HIV
    • Short gut syndrome (D-lactic acidosis)
  • Type B2: drugs and toxins
    • Alcohols
    • Beta agonists
    • Biguanides
    • Carbon monoxide
    • Catecholamines
    • Cocaine
    • Cyanide/nitroprusside
    • Isoniazid
    • Linezolid
    • Nalidic acid
    • NRTIs
    • Propofol
    • Salicylates
    • Theophylline
    • Valproate
  • Type B3: inborn errors of metabolism
    • Gluconeogenesis defects
    • Pyruvate dehydrogenase defects
    • Tricaroxylic acid cycle defects
    • Respiratory chain defects