Lactic Acidosis Questions & Answers

Updated: Apr 27, 2018
  • Author: Kyle J Gunnerson, MD; Chief Editor: Michael R Pinsky, MD, CM, Dr(HC), FCCP, MCCM  more...
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Questions & Answers

Overview

What is the pathogenesis of lactic acidosis?

What is metabolic acidosis?

What are the forms of lactic acid?

What is the historical history of lactic acidosis?

What are the causes of lactic acidosis?

How are hyperlactatemia and lactic acidosis differentiated?

What can cause hyperlactatemia?

Which clinical conditions are associated with lactic acidosis?

What factors contribute to the development of lactic acidosis?

What are the etiologies for lactic acidosis?

What causes metabolic acidosis?

What are the clinical manifestations of metabolic acidosis?

What are the categories of lactic acidosis?

What is type A lactic acidosis?

What causes underutilization of lactate in type A lactic acidosis?

What is type B lactic acidosis?

How many subtypes of type B lactic acidosis are there?

What is type B1 lactic acidosis?

What is type B2 lactic acidosis?

What is type B3 lactic acidosis?

What is the role of septic shock in the pathogenesis of lactic acidosis?

What is the role of glycolysis in the pathogenesis of lactic acidosis?

What is the role of gluconeogenesis in the etiology of lactic acidosis?

What is the role of the liver in the pathogenesis of lactic acidosis?

What are risk factors for lactic acidosis?

What are the metabolic aspects of the pathophysiology of lactic acidosis?

What is the role of ATP hydrolysis in the pathogenesis of lactic acidosis?

What is the role of cellular hypoxia in the pathogenesis of lactic acidosis?

How is the hydrolysis of 2 ATP molecules formed in the pathogenesis of lactic acidosis?

What is the role of oxygen in the pathogenesis of lactic acidosis?

What is a second cellular source of anaerobic ATP in the pathogenesis of lactic acidosis?

What is the role of cellular transport of lactate in the pathogenesis of lactic acidosis?

What is the role of oxygen transport in the pathogenesis of lactic acidosis?

What is the most frequent cause of lactic acidosis?

What is the etiologic relationship between shock and lactic acidosis?

What is the etiologic relationship between sepsis and lactic acidosis?

How does stress hyperlactemia occur in lactic acidosis?

What is the mechanism of lactic acidosis in septic shock?

What are possible mechanisms for hyperlactemia in lactic acidosis?

What is the significance of hyperlactemia in patients with sepsis?

What are the limitations of lactic acidosis as an index of tissue perfusion?

What disorders are possible underlying causes of lactic acidosis?

What is the incidence of lactic acidosis in critically ill patients?

What are the medicinal and toxic causes of lactic acidosis?

What is the role of metformin in the etiology of lactic acidosis?

What is the prevalence of lactic acidosis?

What is the incidence of lactic acidosis?

What is associated with increased survival in cardiac patients with lactic acidosis?

What is the prognostic value of blood lactate concentration for lactic acidosis?

What is the prognosis of antiretroviral-associated hyperlactemia in lactic acidosis?

Which factors decrease mortality rates for lactic acidosis?

What is the clinical significance of mild hyperlactatemia in lactic acidosis?

What is the mortality rate for lactic acidosis?

Which factors increase the survival rate for lactic acidosis?

Which factors increase mortality rate for lactic acidosis?

What are the Surviving Sepsis Campaign treatment guidelines regarding serum lactate levels?

What is the benefit of early lactate normalization in patients with sepsis?

What is the prognosis of lactic acidosis caused by a lactate metabolism disorder?

Presentation

What are characteristics of the onset of lactic acidosis?

What should be the focus of history in suspected lactic acidosis?

What forms the basis of signs and symptoms of lactic acidosis?

In which patients is lactic acidosis most likely?

When should lactic acidosis be suspected?

What is the relationship between lactic acidosis and antiretroviral therapy?

What is the relationship between firmament metabolic acidosis and lactic acidosis?

What is D-lactic acidosis?

Which physical findings are characteristic of lactic acidosis?

What are the clinical signs of impaired tissue perfusion in lactic acidosis?

Which findings suggest shock and hypoperfusion in lactic acidosis?

When might hyperventilation be observed in patients with lactic acidosis?

What are the signs and symptoms of sepsis associated with lactic acidosis?

DDX

Which conditions should be considered in the diagnosis of lactic acidosis?

What are the differential diagnoses for Lactic Acidosis?

Workup

What lab finding suggests lactic acidosis?

What is the role of biochemical markers in the diagnosis of lactic acidosis?

What is the role of noninvasive near-infrared spectroscopy in the diagnosis of lactic acidosis?

What is the role of anion gap in the workup of lactic acidosis?

How is the anion gap calculated in the evaluation of lactic acidosis?

When is adjustment of the anion gap needed in the evaluation of lactic acidosis?

What is the significance of the anion gap in the diagnosis of lactic acidosis?

What is the role of lactate assays in the diagnosis of lactic acidosis?

Which type of blood is preferred for lactate assays in the evaluation of lactic acidosis?

How are samples collected for lactate assays in the evaluation of lactic acidosis?

How are lactate assays used in the evaluation of lactic acidosis?

Which serum lactate levels indicate lactic acidosis?

What is the role of serum lactate measurement in the management of lactic acidosis?

What is the role of arterial blood gas analysis in the diagnosis of lactic acidosis?

What is the role of the strong Ion gap (SIG) in the diagnosis of lactic acidosis?

How is the strong ion gap (SIG) calculated in the evaluation of lactic acidosis?

How is the strong ion gap (SIG) used to predict mortality in lactic acidosis?

Treatment

What are the treatment approaches for lactic acidosis?

How is cardiovascular collapse in lactic acidosis treated?

What is the role of fluid management in lactic acidosis?

What causes respiratory muscle fatigue in lactic acidosis and how is it treated?

What is the role of alkali therapy in the treatment of lactic acidosis?

How is the amount of sodium bicarbonate required for the treatment of lactic acidosis calculated?

How is sodium bicarbonate metabolized in the treatment of lactic acidosis?

Is the role of sodium bicarbonate in the treatment of lactic acidosis?

What is the role of tris-hydroxylmethyl aminomethane (tromethamine [THAM]) in the treatment of lactic acidosis?

What is the role of Carbicarb in the treatment of lactic acidosis?

What is the efficacy of Carbicarb for the treatment of lactic acidosis?

How is hemodialysis used in the treatment of lactic acidosis?

What is the role of methylene blue in the treatment of lactic acidosis?

What is the role of dichloroacetate in the treatment of lactic acidosis?

What is the role of thiamine treatment for lactic acidosis?

What is the treatment for D-lactic acidosis?

What is the role of therapeutic plasma exchange in the treatment of lactic acidosis?

What is the most common etiology for lactic acidosis in patients who are critically ill?

What is the treatment approach for patients with lactic acidosis who are critically ill?

Why is blood lactate concentration monitored during treatment of lactic acidosis in critically ill patients?

Which specialist consultations are needed in the management of lactic acidosis?

Medications

What is the definitive treatment for lactic acidosis?

Which medications in the drug class Vitamins are used in the treatment of Lactic Acidosis?

Which medications in the drug class Alkalinizing Agents are used in the treatment of Lactic Acidosis?