Lactic acidosis
Summary
Lactic acidosis is an anion gap metabolic acidosis (lactate >5 mmol/L) classified as Type A (tissue hypoperfusion) or Type B (no hypoxia). Type A is seen in sepsis/shock; Type B with seizures, malignancy, or medications (metformin).
Detail
Type A develops from inadequate oxygen delivery shifting metabolism to anaerobic glycolysis. Type B occurs without systemic hypoxia but involves local tissue hypoxia, impaired hepatic clearance, or specific medications (metformin, NRTIs). D-lactic acidosis is rare, seen in short bowel syndrome from bacterial fermentation. Diagnosis: pH <7.35 and lactate >5 mmol/L. Management: treat underlying cause (restore perfusion in Type A, remove offending agent in Type B).
Sources
- First Aid for the USMLE Step 1
- Pathoma
- Harrison's Principles of Internal Medicine
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