Lactic acidosis: Difference between revisions

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'''For patient information, click [[Lactic acidosis (patient information)|here]]'''
{{Infobox_Disease |
  Name          = Lactic acidosis |
  Image          = Lactic-acid-skeletal.png  |
  Caption        = [[Lactic acid]] |
}}
{{Lactic acidosis}}
{{Lactic acidosis}}
'''For patient information, click [[Lactic Acidosis (patient information)|here]]'''
{{CMG}}
{{CMG}}


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==[[Lactic acidosis overview|Overview]]==
==[[Lactic acidosis overview|Overview]]==
Lactic acid is a carbohydrate and its levels rise with increased metabolism during exercise and with catecholamine stimulation. The excess of lactic acid in the body causes muscle pain and serum levels above 4mmol/L and a blood pH ≤7.35, and occurs when oxygen levels in the body drop (hypoxia). The occurrence of LA in type 2 diabetes is of great concern because the mortality rate of LA can be as high as 50%
==[[Lactic acidosis historical perspective|Historical Perspective]]==
==[[Lactic acidosis historical perspective|Historical Perspective]]==
Scherer was the first to record lactic acid in human blood in 1843. Subsequent work by Carl Folwarczny in 1858 built upon the understanding of the condition.<br />
==[[Lactic acidosis classification|Classification]]==
==[[Lactic acidosis classification|Classification]]==
Lactic acidosis is classified into Type A (hypoxemic) and type B (due to underlying conditions or drugs). <br />
==[[Lactic acidosis pathophysiology|Pathophysiology]]==
==[[Lactic acidosis pathophysiology|Pathophysiology]]==
A general idea about the development of lactic acidosis is that any mechanisms that increase production of, or decrease clearance of lactate lead to lactic acidosis. <br />
==[[Lactic acidosis causes|Causes]]==
==[[Lactic acidosis causes|Causes]]==
<br />
==[[Lactic acidosis differential diagnosis|Differentiating Lactic acidosis from other Diseases]]==
==[[Lactic acidosis differential diagnosis|Differentiating Lactic acidosis from other Diseases]]==
Lactic acidosis should be differentiated from:
*Any shock state
*SIRS; lactate may be 2-5 mEq/L
*Thiamine deficiency
*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)
<br />
==[[Lactic acidosis epidemiology and demographics|Epidemiology and Demographics]]==
==[[Lactic acidosis epidemiology and demographics|Epidemiology and Demographics]]==
Lactic acidosis is a rare event, with an estimated incidence of 4.3 cases per 100,000 person-years in metformin users. The occurrence in type 2 diabetes is alarming as the mortality can be up to 50%. A secondary analysis of more than 41,000 person-years in type 2 diabetes showed that the incidence of LA in diabetic patients not exposed to metformin was between 9.7 and 16.7 per 100,000 person-years. Lactic acidosis often occurs in patients with acute severe asthma, most likely due to fatiguing respiratory muscles and subsequent inadequate oxygen delivery to the muscles and liver ischemia. Severe lactic acidosis also occurs in sedated mechanically ventilated patients without respiratory muscle activity.<br />
==[[Lactic acidosis risk factors|Risk Factors]]==
==[[Lactic acidosis risk factors|Risk Factors]]==
<br />
==[[Lactic acidosis natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
==[[Lactic acidosis natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
Lactic acidosis in critically ill patients is associated with a high mortality rate; it has the highest mortality as compared with other types of acidoses. <br />
 
==Diagnosis==
==Diagnosis==
[[Lactic acidosis history and symptoms|History and Symptoms]] | [[Lactic acidosis physical examination|Physical Examination]] | [[Lactic acidosis laboratory findings|Laboratory Findings]]
[[Lactic acidosis history and symptoms|History and Symptoms]] | [[Lactic acidosis physical examination|Physical Examination]] | [[Lactic acidosis laboratory findings|Laboratory Findings]]


<br />
==Treatment==
==Treatment==
[[Lactic acidosis medical therapy|Medical Therapy]] | [[Lactic acidosis primary prevention|Primary Prevention]] | [[Lactic acidosis secondary prevention|Secondary Prevention]] | [[Lactic acidosis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Lactic acidosis future or investigational therapies|Future or Investigational Therapies]]
[[Lactic acidosis medical therapy|Medical Therapy]] | [[Lactic acidosis primary prevention|Primary Prevention]] | [[Lactic acidosis secondary prevention|Secondary Prevention]] | [[Lactic acidosis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Lactic acidosis future or investigational therapies|Future or Investigational Therapies]]


<br />
==Case Studies==
==Case Studies==
[[Lactic acidosis case study one|Case #1]]


<br />
==Related Chapters==
*[[Metabolic acidosis]]
<br />
==Additional Resources==
*Clinical Physiology of Acid-Base and Electrolyte Disorders by Rose, Post
*Intensive Care Medicine by Irwin and Rippe
*The ICU Book by Marino
*Cohen R, Woods H. ''Clinical and Biochemical Aspects of Lactic Acidosis''. Blackwell Scientific Publications; 1976. ISBN 0-632-09460-5.


[[Category:Electrolyte disturbance]]
[[Category:Electrolyte disturbance]]
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[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
[[Category:Intensive care medicine]]
[[Category:Intensive care medicine]]
{{Endocrine, nutritional and metabolic pathology}}


[[es:Acidosis láctica]]
[[es:Acidosis láctica]]
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Latest revision as of 21:08, 4 February 2022

Lactic acidosis Microchapters

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Overview

Historical Perspective

Classification

Pathophysiology

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Differentiating Lactic acidosis from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Treatment

Medical Therapy

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

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Case #1

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For patient information, click here Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and keywords: Lactate levels raised (plasma or serum); lactic acidemia; lactic acidaemia.

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Lactic acidosis from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings

Treatment

Medical Therapy | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies