Lactic acidosis

Last updated: Friday, 17, December, 2010
CausesAppropriate Tests

Blood gases; L-lactate, electrolytes, urea, creatinine; hydroxybutyrate if ketoacidosis also suspected; urate.

Shock, including

  • Sepsis
  • Hypovolaemia



See Septicaemia

Asphyxia, including

  • Grand mal fits 

Heart failure (severe)

See Cardiac failure

Drug toxicity, including

  • Metformin toxicity
  • Salicylate toxicity
Salicylate. See Therapeutic drug monitoring
  • Ethanol toxicity
Ethanol.

Hepatic failure

Genetic (without hypoglycaemia)

  • Mitochondrial disorders
  • Pyruvate dehydrogenase deficiency

Pyruvate. Muscle biopsy - histology; enzyme assays and molecular genetics - consult pathologist before biopsy.

Genetic (with hypoglycaemia)

  • Type l glycogen disease
Glucose, pyruvate. Liver biopsy with histology, enzyme studies, glycogen - consult pathologist before biopsy.

D-lactic acidosis

  • Bowel bacterial overgrowth
D-lactate - consult pathologist.

Respiratory alkalosis

The associated, compensatory, metabolic acidosis often includes elevation of plasma lactate. See Alkalosis

Artefactual

Prolonged storage of blood at room temperature before separation. See Table 1 Artefactual results