Lactic acidosis laboratory findings: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Lactic acidosis}} | {{Lactic acidosis}} | ||
{{CMG}} | {{CMG}} {{AE}} {{Skhan}} | ||
==Laboratory Findings== | ==Laboratory Findings== | ||
*Blood tests are used to check electrolyte levels. Lactate levels in the blood are monitored. | *Blood tests are used to check electrolyte levels typically showing a low plasma bicarbonate (<22 mmol/L). Lactate levels in the blood are continuously monitored. | ||
*Arterial blood gases usually show a metabolic acidosis (pH <7.35 with low or normal pCO2). In the absence of obvious acidic toxins or ketone bodies, the situation points to lactic acidosis. The anion gap will be elevated in lactic acidosis. The anion gap should be calculated as below: | |||
**The [[anion gap]] is the difference between the sum of the [[cations]] (sodium plus potassium) and the [[anions]] (chloride plus bicarbonate), | |||
***([Na mmol/L] + [K mmol/L]) − ([Cl mmol/L] + [HCO3 mmol/L]). | |||
* Anion gap is also elevated in [[chronic kidney disease]] and other [[Organic acidemia|organic acidoses]], [[ketoacidosis]], and some drug induced acidoses. | |||
* Keep in mind that clinically significant hyperlactataemia can occur in the absence of a raised anion gap. | |||
* Samples for lactate estimation should be taken from [[Arterial line|arterial]] or [[Central venous line|mixed central venous]] sites, since peripheral values may reflect local rather than systemic concentrations. | |||
* Further investigations aimed at detecting the underlying cause should be requested as thought necessary. Blood, urine and other cultures are useful for detecting occult septic causes. | |||
* References | |||
{{Reflist|2}} | {{Reflist|2}} | ||
Latest revision as of 12:46, 15 December 2021
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Saud Khan M.D.
Laboratory Findings
- Blood tests are used to check electrolyte levels typically showing a low plasma bicarbonate (<22 mmol/L). Lactate levels in the blood are continuously monitored.
- Arterial blood gases usually show a metabolic acidosis (pH <7.35 with low or normal pCO2). In the absence of obvious acidic toxins or ketone bodies, the situation points to lactic acidosis. The anion gap will be elevated in lactic acidosis. The anion gap should be calculated as below:
- Anion gap is also elevated in chronic kidney disease and other organic acidoses, ketoacidosis, and some drug induced acidoses.
- Keep in mind that clinically significant hyperlactataemia can occur in the absence of a raised anion gap.
- Samples for lactate estimation should be taken from arterial or mixed central venous sites, since peripheral values may reflect local rather than systemic concentrations.
- Further investigations aimed at detecting the underlying cause should be requested as thought necessary. Blood, urine and other cultures are useful for detecting occult septic causes.
- References