Chapter 156 Lactate Monitoring Flashcards
Lactate exists in two forms. Which form is produced by mammalian cells and the form that most clinical analyzers measure?
L-lactate.
D-lactate is produced by some forms of bacteria.
True or false: hyperlactatemia can occur in the presence of aerobic metabolism.
True! Hyperlactatemia can occur in anaerobic and aerobic metabolism.
What is type I hyperlactatemia?
Patients with no change in serum pH and concurrent hyperlactatemia.
What is type 2 hyperlactatemia and what are the subtypes and their definitions?
Type 2 lactic acidosis is hyperlactatemia with concurrent acidemia.
Type 2A lactic acidosis due to inadequate oxygen delivery to meet cellular demand
Type 2B-causes of LA that occur despite adequate oxygen delivery
What are specific causes of type 2A Lactic acidosis? (inadequate oxygen delivery for cellular demand)
Shock (cardiogenic, septic, hypovolemia, hypoxic), regional hypoperfusion (splanchnic), severe hypoxemia, severe, acute anemia, CO toxicity, muscle activity: seizures, trembling, shivering, exercise, excessive restraint
Type B Lactic acidosis is LA with no evidence of inadequate oxygen deliver and can be divided into 1B, 2B and 3B. What are examples of type 1B LA?
LA associated with underlying disease: DM, liver disease, neoplasia, sepsis, phenochromocytoma, thiamine deficiency
What are examples of type 2B LA?
Drugs or toxins: ethanol, methanol, ethylene glycol, sorbitol, xylitol, salicylates, acetominophen, epinephrine, terbutaline, cyanide, propylene glycol
What are examples of type 3B LA?
Due to inborn errors: glycogen storage disease, pyruvate dehydrogenase phosphatase deficiency, mitochondrial oxidative disorders
When should a typeB lactic acidosis be suspected?
If lactic acidosis persists without any evidence of inadequate oxygen delivery
Why does the presence of a normal anion gap not exclude an elevated lactate?
Because many emergency and critically ill patients have concurrent hypoalbuminemia, leading to a decreased anion gap.
When measuring lactate in abdominal effusion, what value has a 100% sensitivity and specificity in detecting bacterial peritonitis (study of 7 dogs).
Abdominal fluid lactate that is 2 mmol/L higher than peripheral lactate.
