Lactic acidosis classification
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Saud Khan M.D.
Overview
Lactic acidosis is classified as type A and type B according to the root cause being either a shortage of oxygen or other metabolic/acquired factors respectively.
Classification
The Cohen-Woods classification (1976) categorizes causes of lactic acidosis as follows:
- Type A: Decreased perfusion or oxygenation: Occurs due to an oxygen demand/supply mismatch, causing anaerobic glycolysis. Examples include all shock states (septic, cardiogenic, hypovolemic, obstructive), regional ischemia (limb, mesenteric), seizures/convulsions, and severe cases of shivering.
- Type B: Defined as not having to do with tissue hypoxia or hypoperfusion.
- B1: Underlying diseases (sometimes causing type A) such as liver disease, malignancy, HIV, thiamine deficiency, diabetic ketoacidosis.
- B2: Medication or intoxication example metformin, epinephrine, total parenteral nutrition, ethanol.
- B3: Inborn error of metabolism, such as mitochondrial myopathy, congenital lactic acidosis.