Lactic acidosis (Assessment and Plan)
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Author: William J Gibson MD, PhD
# Lactic acidosis
Noted to have lactate of XX. Bicarb XX and ABG revealed pH XX. Most likely cause of elevated lactate is hypoperfusion due to XX, though differential includes both type A and type B etiologies as below.
Differential includes:
Type A (hypoperfusion): septic vs cardiogenic shock
Type B (no hypoperfusion): liver disease, diabetes, malignancy, alcoholism, beta agonists, mitochondrial dysfunction, drugs ( salicylates, NRTI, propofol, linezolid), regional ischemia
D-lactic acidosis (rare): short gut, DKA
Dx:
- Lactate Q6H, ABG, tox screen, LFTs
Tx:
- Treat underlying cause
- IV fluids (eg 1L LR bolus)
- Consider thiamine and riboflavin supplementation