Lactic acidosis (Assessment and Plan)

Author: William J Gibson MD, PhD

# Lactic acidosis

Noted to have lactate of XX. Bicarb XX and ABG revealed pH XX. Most likely cause of elevated lactate is hypoperfusion due to XX, though differential includes both type A and type B etiologies as below.

Differential includes:

Type A (hypoperfusion): septic vs cardiogenic shock

Type B (no hypoperfusion): liver disease, diabetes, malignancy, alcoholism, beta agonists, mitochondrial dysfunction, drugs ( salicylates, NRTI, propofol, linezolid), regional ischemia

D-lactic acidosis (rare): short gut, DKA

Dx:

– Lactate Q6H, ABG, tox screen, LFTs

Tx:

– Treat underlying cause

– IV fluids (eg 1L LR bolus)

– Consider thiamine and riboflavin supplementation