Lab Case 117 – Interpretation

A 37 year old man presents feeling unwell.

His blood tests show:Normal anion gap metabolic acidosis


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)