Other

Question 1

What is the definition of hyperlactataemia and lactic acidosis?

Answer 1

Hyperlactatataemia = serum lactate >2
Lactic acidosis = serum lactate >4; even in the absence of overt acidemia

Question 2

How do you differentiate Type A from Type B Lactic Acidosis?

Answer 2

Type A Lactic Acidosis = caused by impaired tissue oxygenation

Type B Lactic acidosis = not caused by impaired tissue oxygenation

Therefore Type A usually has manifestations of hypoperfusion/shock incl reduced urine output, hypotension, cool or clammy extremities, altered mental status

Question 3

What are the main causes of Type B Lactic Acidosis?

Answer 3

1) Diabetes - secondary to ketoacidosis or metformin toxicity
2) Malignancy - incl lеukеmia, lymрhoma, and solid malignancies
3) Alcoholism - esp chronic, severe alcoholism
4) Methanol and ethylene glycol poisoning
5) HIV antiretroviral medication-induced mitochondrial dysfunction
6) Beta-adrenergic therapy - eg salbutamol
7) Inherited mitochondrial disorders eg MELAS (Mitochondrial Encephalopathy with Lactic Acidosis and Stroke-like episodes syndrome
8) Thiamine deficiency
9) Propofol therapy
10) Linezolid therapy