Life threatening lactic acidosis

Classification of causes of lactic acidosis 1 Type A Poor tissue perfusion Shock (hypovolaemic, cardiogenic, haemorrhagic, or septic) Acute hypoxaemia Carbon monoxide poisoning Type B1 Renal failure Diabetes Liver disease Infection (especially AIDS) Leukaemia, lymphoma, large tumours Thiamine deficiency in alcohol misuse (inhibition of pyruvate dehydrogenase) Type B2 Ingestion or administration of drugs or other toxic substances: â[euro]¢Metformin â[euro]¢Antiretroviral treatment for HIV infection with nucleoside analogue reverse transcriptase inhibitors â[euro]¢Cancer chemotherapy â[euro]¢Ethanol â[euro]¢Toluene â[euro]¢Sorbitol â[euro]¢Salicylates â[euro]¢Isoniazid â[euro]¢Nitroprusside â[euro]¢Cyanide Type B3 Hereditary forms: â[euro]¢Glucose-6-phosphate deficiency (type I glycogenosis) â[euro]¢Fructose-1,6-diphosphatase deficiency â[euro]¢Pyruvate carboxylase deficiency â[euro]¢Pyruvate dehydrogenase deficiency â[euro]¢Deficiencies of oxidative phosphorylation â[euro]¢Methylmalonicaciduria 2 What is the most likely diagnosis? In case of circulatory shock or acute respiratory failure, endotracheal intubation should be performed and mechanical ventilation must be instituted. Because septic shock is common in this situation, empirical broad spectrum antibiotics must be given immediately.