A 55-year-old man on ICU develops hyperlactataemia (lactate 5.5 mmol/L) despite haemodynamic stability (MAP 72, CI 3.5, ScvO2 70%). He is receiving a ...

Question

A 55-year-old man on ICU develops hyperlactataemia (lactate 5.5 mmol/L) despite haemodynamic stability (MAP 72, CI 3.5, ScvO2 70%). He is receiving a metformin-containing medication and has mild AKI (creatinine 180 µmol/L). The team suspects type B lactic acidosis. What distinguishes type A from type B lactic acidosis?

Accepted Answer

Type A results from tissue hypoxia/hypoperfusion (shock, severe hypoxaemia, severe anaemia, CO poisoning); Type B results from impaired lactate metabolism or increased production WITHOUT tissue hypoxia - causes include metformin, liver failure, malignancy, thiamine deficiency, mitochondrial dysfunction, seizures, and beta-2 agonists

Answer

There is no difference

Answer

Type B is always benign

Answer

Type A only occurs in cardiac arrest

Answer

Type B requires no treatment

uk-fficm MCQ (SBA): Type A vs Type B Lactic Acidosis