A 37 year old man presents feeling unwell.
His blood tests show:Normal anion gap metabolic acidosis
Uncompensated
Very high lactate
Very high Chloride
Chloride can account for the NAGMA
Is there a possible cause for the lactic acidosis
Causes of lactic acidosis:
| Classification of Some Causes of Lactic Acidosis (Cohen & Woods, 1976) |
| Type A Lactic Acidosis : Clinical Evidence of Inadequate Tissue Oxygen Delivery |
- Anaerobic muscular activity (eg sprinting, generalised convulsions)
- Tissue hypoperfusion (eg shock -septic, cardiogenic or hypovolaemic; hypotension; cardiac arrest; acute heart failure; regional hypoperfusion esp mesenteric ischaemia; malaria)
- Reduced tissue oxygen delivery or utilisation (eg hypoxaemia, carbon monoxide poisoning, severe anaemia)
|
| Type B Lactic Acidosis: No Clinical Evidence of Inadequate Tissue Oxygen Delivery |
- type B1 : Associated with underlying diseases (eg ketoacidosis, leukaemia, lymphoma, AIDS)
- type B2: Assoc with drugs & toxins (eg phenformin, cyanide, beta-agonists, methanol, nitroprusside infusion, ethanol intoxication in chronic alcoholics, anti-retroviral drugs)
- type B3: Assoc with inborn errors of metabolism (eg congenital forms of lactic acidosis with various enzyme defects eg pyruvate dehydrogenase deficiency)
|
