Clinical Pearls: Lactate

Last week Dr. Skaug presented a fascinating case of recurrent lactic acidosis of unclear etiology. Here is a succinct review of the differential for lactic acidosis:

  • Type A (Most Common): Tissue hypoperfusion resulting from hypovolemia, cardiac failure, sepsis, or cardiopulmonary arrest.
  • Type BEvidence of systemic hypoperfusion is not apparent
    • Diabetes (Metformin Related and D-Lactate)
    • Malignancy
    • Alcoholism
    • Mitochondrial Dysfunction (Drugs, Sepsis)
    • D Lactate (Excessive gut fermentation producing D lactate)


For further information please reference this excellent review article in CHEST