Lactic Acidosis
Physical Findings:
The physical examination also varies according to the underlying cause of lactic acidosis. Cardiovascular compromise is a frequent finding, explaining many of the associated signs, which include cyanosis, cold extremities, tachycardia, hypotension, signs of dehydration, hyperventilation or dyspnea, lethargy, stupor or coma, vomiting, and/or abdominal pain.....
The most frequent cause of lactic acidosis is poor perfusion, which is induced by various shock states, overwhelming infection, or other causes of hypoxia. Medicinal and toxic causes of lactic acidosis are quite numerous, including acetaminophen, alcohols and glycols (ethanol, ethylene glycol, methanol, propylene glycol), almitrine, antiretroviral nucleoside analogs (zidovudine, delavirdine, didanosine, lamivudine, stavudine, zalcitabine), beta-adrenergic agents (eg, epinephrine, ritodrine, terbutaline), biguanides (phenformin, metformin), cocaine, cyanogenic compounds (eg, cyanide, aliphatic nitriles, nitroprusside), diethyl ether, 5-fluorouracil, halothane, iron, isoniazid, nalidixic acid, propofol, sugars and sugar alcohols (fructose, sorbitol, and xylitol), salicylates (eg, Reye syndrome), strychnine, sulfasalazine, and valproic acid.
Lactic acidosis also may occur in association with an underlying disease, such as diabetes mellitus, severe iron-deficiency anemia, liver diseases, alcoholic ketoacidosis, pancreatitis, malignancy (eg, leukemias, lymphomas, lung cancer), alkalosis, infections (malaria, cholera), renal failure, pheochromocytoma, thiamine deficiency, short gut syndrome and other carbohydrate malabsorption syndromes (eg, d-lactic acidosis), and milk protein intolerance.
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