Causes of lactic acidosis

Lactic acidosis occurs when production of lactic acid is in excess of removal. The major sources are skeletal muscle, brain and red blood cells. Removal is mainly by metabolism to glucose in the liver and kidney. Hepatic removal is impaired by poor perfusion and acidosis. Lactic acidosis is traditionally classified as type A or type B. Type A refers to excess production when tissue oxygenation is inadequate. Type B occurs where there is no systemic tissue hypoxia. Epinephrine therapy may cause accelerated aerobic glycolysis and pyruvate production in excess of mitochondrial needs; this may produce an increasing metabolic acidosis often out of proportion to the patient's clinical status. In sepsis, hyperlact ataemia is mainly due to increased muscle Na + K+-ATPase activity. Treatment of metabolic acidosis with sodium bicarbonate solution may increase lactate production. A severe and persistent type A lactic acidosis is associated with a poor outcome.

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