Lactic acidosis classification

Lactic acidosis is classified as type A and type B according to the root cause being either a shortage of oxygen or other metabolic/acquired factors respectively.

The Cohen-Woods classification (1976) categorizes causes of lactic acidosis as follows:

• Type A: Decreased perfusion or oxygenation: Occurs due to an oxygen demand/supply mismatch, causing anaerobic glycolysis. Examples include all shock states (septic, cardiogenic, hypovolemic, obstructive), regional ischemia (limb, mesenteric), seizures/convulsions, and severe cases of shivering.
• Type B: Defined as not having to do with tissue hypoxia or hypoperfusion.
  • B1: Underlying diseases (sometimes causing type A) such as liver disease, malignancy, HIV, thiamine deficiency, diabetic ketoacidosis.
  • B2: Medication or intoxication example metformin, epinephrine, total parenteral nutrition, ethanol.
  • B3: Inborn error of metabolism, such as mitochondrial myopathy, congenital lactic acidosis.

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