View source for Template:Lactic acidosis DDX

===[[Lactic acidosis]]===
====By Type====
*'''Type A (tissue hypoperfusion)'''
**[[Hypovolemia]]
**[[heart failure|Cardiac failure]]
**[[Sepsis]]
*'''Type B (decreased utilization)'''
**[[alcohol Abuse|Alcoholism]]
***↓ Lactate utilization secondary to hepatic dysfunction
***↓ NAD+/NADH ratio leads to ↑ conversion of pyruvate to lactate
**[[Metformin]]
**[[DKA]]
***Mainly due to D-lactate production, though hypovolemia contributes
**[[hepatic failure|Liver disease]] (decreased clearance)
**Adrenergic receptor agonism; viz., [[albuterol]], [[epinephrine]], etc
**Malignancy
**[[Carbon Monoxide]] poisoning
**[[Cyanide]] poisoning
*'''Type D'''
**episodes of encephalopathy and metabolic acidosis typically following high carbohydrate meals in patients with short bowel syndrome
**metabolic acidosis and high serum anion gap, normal lactate level, short bowel syn or other forms of malabsorption, and characteristic neurologic findings
***Type D lactate is not detected with standard lactate levels

====Complete List====
*Any [[shock]] state
*[[SIRS]]; lactate may be 2-5 mEq/L
*[[Thiamine deficiency]]; more often seen in ICU settings; Thiamine is a co-factor for pyruvate dehydrogenase
*[[Seizure]]
*[[ischemic bowel|Dead gut]]
*[[Hepatic failure]]
*Malignancy
*Exercise
*[[Albuterol]] and other beta agonists<ref>Dodda V and Spiro P. Albuterol, an Uncommonly Recognized Culprit in Lactic Acidosis. Chest. 2011;140.</ref><ref>. Zitek T, Cleveland N, Rahbar A, et al. Effect of nebulized albuterol
on serum lactate and potassium in healthy subjects. Acad Emerg
Med 2016;23:718–21.</ref>
*Toxicologic Causes:
**[[Cyanide]]
**[[Carbon Monoxide]]
**[[Metformin]]
**Didanosine
**Stavudine
**Zidovudine
**[[Linezolid]]
**[[Strychnine]]
**Emtriva
**Rotenone (Fish Poison
**NaAzide (Lab Workers)
**[[APAP]] (if Liver Fx)
**Phospine (rodenticide)
**NaMonofluoroacetate (Coyote Poison‐ give Etoh as antidote)
**[[INH]] (if patient seizes)
**Hemlock
**[[Valproate]]
**[[Hydrogen Sulfide]]
**[[Nitroprusside]] (if cyanide toxic)
**[[Ricin]] & Castor Beans
**[[Propofol]]
**[[Sympathomimetics]] (cocaine, methamphetamine)
**Jequirty peas (Abrus precatorius)
**Prunus Amygdalus plants
**Crab tree apple seeds & cassava (yucca)
**[[HAART-induced lactic acidosis]]