Lab
Blood Lactic Acid
search
Blood Lactic Acid
, Lactic Acidosis, Lactic Acidosis Definition, Lactic Acid
Physiology
See
Glucose Metabolism
Causes
Tissue
Hypoxia
(Type A)
Systemic hypoperfusion or shock
Hypovolemia
or
Dehydration
Cardiogenic Shock
Septic Shock
Seizure
(transient)
Local hypoperfusion
Testicular Torsion
Intestinal Volvulus
Acute Mesenteric Ischemia
Arterial embolism (e.g.
Cerebrovascular Accident
)
Epinephrine
infusion (causing tissue
Hypoxia
)
Decreased arterial oxygen
Hypoxemia
(e.g.
Asthma
)
Severe
Anemia
Carbon Monoxide Poisoning
Causes
No tissue
Hypoxia
(Type B)
Medical conditions (Type B1)
Severe liver disease (related to Cori Cycle Lactic Acid generation)
Cancer
Thiamine deficiency
Medications or toxins (Type B2, most are via mitochondrial cytopathy)
Acetaminophen
Cyanide
Metformin
Beta-2 Agonist (via increased pyruvate)
Albuterol
10 mg neb increases Lactic Acid 0.8 mmoL/L
Zitek (2016) Acad Emerg Med 23(6): 718-21 +PMID:26857949 [PubMed]
Isoniazid
(via liver toxicity)
Tetracycline
Linezolid
Propofol
Causes
Propofol Infusion Syndrome
Propylene gylcol (solvent for many parenteral drugs)
Nitroglycerin
Lorazepam
Etomidate
Phenytoin
Nucleoside Reverse Transcriptase Inhibitor
(NRTI agents)
Zidovudine
Lamivudine
Didanosine
Stavudine
Toxic
Alcohol
ingestion
Ethylene Glycol Poisoning
Methanol Poisoning
Congenital metabolic conditions (Type B3)
Mitochondrial disorders
Hypoglycemia
Precations
Lactic Acid is primarily used as a
Sepsis
marker and tissue ischemia marker (e.g. ischemic bowel)
However, differential diagnosis of Lactic Acidosis is broad (see above)
Avoid ordering Lactic Acid in low risk patients (non-toxic, previously healthy)
Consider superimposed factors resulting in Lactic Acidosis (
Asthma
,
Albuterol
)
Lactic Acid clearance outside
Sepsis
does not uniformly improve with
Intravenous Fluid
s
Cardiogenic Shock
can also increase Lactic Acid and will worsen with excess fluids
Outside
Sepsis
,
Exercise
caution in aggressive fluid
Resuscitation
to lower Lactic Acid
References
Herbert and Crager in Herbert (2018) EM:Rap 18(4): 1-3
Efficacy
Children
Lactic Acid has historically not been used in children, as much as it has become a mainstay in adult evaluation
Lactic Acid may have more evidence for use in sick children (esp.
Sepsis
,
Trauma
) and their disposition
Increased organ dysfunction in children with elevated Lactic Acid >4 mmol/L
Scott (2012) Acad Emerg Med 19(11): 1276-80 +PMID: 23167859 [PubMed]
Predicted need for
Critical Care
in children with
Trauma
and pre-hospital elevated Lactic Acid >4 mmol/L
Shah (2013) Pediatr Emerg Care 29(6): 715-9 +PMID: 23714761 [PubMed]
Predicted in-hospital mortality for critically ill children
Bai (2014) BMC Pediatr 14:83 +PMID: 24673817 [PubMed]
References
(2013) Endo and Acid Base Disorders, EM Bootcamp, Las Vegas
Type your search phrase here