Lactic acidosis differential diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Saud Khan M.D.

Lactic acidosis must be differentiated from other diseases that cause elevated lactate Any shock state or dysfunction of the metabolic pathway responsible for lactate clearance or production can underlie lactic acidosis. A few are:

• Inborn errors of metabolism
• Cardiogenic shock
• Cardiogenic pulmonary edema

Lactic acidosis should be differentiated from:

• Any shock state
• SIRS; lactate may be 2-5 mEq/L
• Thiamine deficiency
• D-lactic acidosis
• 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)

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