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11 Cards in this Set

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Lactic acidosis is defined as:
increased lactate levels > 5 mmol/L, with a low pH (<7.35).
A persistent lactate level >5 mmol/L, even with fluid and drug resuscitation to treatment for the hypotension, has a mortality rate as high as
90%
-Shock (cardiogenic, septic, hypovolemic)
-Regional hypoperfusion (limb, mesenteric ischemia)
-Severe hypoxemia
-Severe anemia
-Carbon monoxide poisoning
causes of what type of LA
Type A
1. B1 (LA occurring in association with and underlying disease)
a. Diabetes mellitus (Ketoacidosis)
b. Liver disease
c. Sepsis (as a separate issue unrelated to hypotension)
2. B2 (LA due to drugs/toxins). Short list: Ethanol, Methanol, Ethylene glycol, Salicylates, Acetaminophen, Epinephrine, Terbutaline, Nitroprusside, Propylene glycol (anti-freeze), Β2 Agonists*
3. B3 (LA due to inborn errors in metabolism)
a. Von Gierke’s disease
4. Miscellaneous
5. Hypoglycemia.
causes of what type of LA?
Type B
Aerobic pathway:
O2 + Glucose → pyruvic acid → CO2 + H2O + 34 mmol of ATP (1270 kJ of energy)
Anaerobic pathway:
Glucose → pyruvic acid → Lactic acid + 2 mmol of ATP (67 kJ of energy)
process of:
citric acid cycle
Lactic acid → Pyruvate → Glucose
-process of:
Cori cycle
the process in which lactic acid is cleared:
Gluconeogenesis
lactic acidosis should be suspected if a patient has either:
an anion gap or hypotension.
The normal blood concentration of lactic acid ranges between
0.5 to 1.5 mmol/L
A persistent lactate level _____ even with fluid and drug resuscitation to treatment for the hypotension, has a mortality rate as high as
>5 mmol/L,
90%.
potentially causes respiratory depression, severe acute hypokalemia and a leftward shift of the oxyhemoglobin dissociation curve that may worsen tissue hypoxia.
- possible outcomes of:
bicarbonate administration