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Lactic Acidosis (Emergency Evaluation)

High anion gap metabolic acidosis: type A vs type B etiology and targeted treatment

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Dahiliye (İç Hastalıkları) department. Book Appointment →

What is Lactic Acidosis (Emergency Evaluation)?

Lactic acidosis is a metabolic acidosis caused by elevated serum lactate. Type A develops with anaerobic metabolism due to inadequate tissue oxygen delivery, most commonly in septic shock, cardiogenic shock, hypovolemia, severe anemia, and respiratory failure.

Type B does not stem from hypoxia and includes drugs (metformin, propofol, NRTIs, linezolid), liver failure, malignancy, thiamine deficiency, mitochondrial dysfunction, and inborn errors of metabolism. The Cohen-Woods classification subdivides the underlying mechanism.

A serum lactate >4 mmol/L is a marker of poor prognosis; mortality in septic shock exceeds 40%. Lactate clearance (>10% over 2 hours) correlates with response to therapy. Type B2 (metformin-associated lactic acidosis - MALA) is rare but carries 30-50% mortality.

Symptoms

Tachypnea and Kussmaul respiration (compensatory)
Altered mental status, confusion, lethargy
Nausea, vomiting, abdominal pain
Hypotension and tachycardia (in shock)
Cold extremities, mottled skin, prolonged capillary refill
Oliguria and acute kidney injury

Risk Factors

Sepsis and septic shock
Metformin use (especially with renal impairment)
Liver failure (impaired lactate clearance)
Malignancy (especially hematologic - Warburg effect)
Cardiac arrest and post-resuscitation
HIV antiretroviral therapy (NRTIs)

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Unexplained tachypnea and respiratory distress
  • Severe altered mental status
  • Hypotension and signs of shock
  • Severe acidosis on metformin therapy
  • Persistent abdominal pain with elevated lactate
  • Lactate >4 mmol/L on lab evaluation

Treatment Methods

01
Treat underlying cause (sepsis source control, fluid resuscitation, vasopressors)
02
Aggressive crystalloid resuscitation (30 mL/kg in septic shock)
03
Discontinue offending drug (metformin, linezolid, propofol)
04
Hemodialysis (severe MALA, lactate >20 mmol/L)
05
Sodium bicarbonate (controversial; pH <7.1 only)
06
Thiamine supplementation (suspected deficiency, alcoholic patients)

Which Department to Visit?

You can visit our Dahiliye (İç Hastalıkları) department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

Learn About Dahiliye (İç Hastalıkları) Department

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.