Lactate

Lactic acid (2-hydroxypropanoic acid)

L-lactic acid produced by animals

D-lactic acidosis from bacterial overgrowth (usually short-gut syndrome)

Type A lactic acidosis = increased production (e.g., anaerobic metabolism)

Type B lactic acidosis = impaired metabolism (e.g., hepatic failure)

Thiamine is needed for lactate metabolism via pyruvate dehydrogenase

Image source Andersen, et al. Critical Care 2016

Methanol Toxin (formate)

Uremia Uremia (sulphates, phosphates, etc.)

DKA Ketoacids (beta-hydroxybutyrate, acetoacetate)

Paracetamol Toxin (5-oxoproline = pyroglutamate) (alt. paraldehyde -> acetate)

Isoniazid (INH) Lactate (from seizures)

Lactate Lactate*

Ethylene Glycol Toxin (oxalate)

Salicylates Toxin (salicylate, + lactate, ketoacids)

*Other causes of lactic acidosis: Cyanide, Carbon Monoxide, Metformin, Didanosine, Stavudine, Strychnine, Emtriva, Rotenone (Fish Poison), NaAzide (Lab Workers), Apap (if Liver Fx), Phospine (rodenticide), NaMonofluoroacetate (Coyote Poison‐Give Etoh as antidote), INH (if patient Seizes), Hemlock, Depakote, Hydrogen Sulfide, Nitroprusside (If cyanide toxic), Ricin, Propofol, & Jequerty Bean

Serum Osmolarity: 2(Na) + glucose/18 + BUN/2.8 + etoh/4.6