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- Hyperlactatemia : Lactate > 2 mmol/L
- Lactic acidosis : Lactate > 4 mmol/L
SOFA 中的 Septic shock 定義 Lactate > 18 mg/dL
換算起來是等於 2 mmol/L
- 病人 lactic acidosis, 原因不是只有休克缺氧周邊組織灌流不足
Type A = 組織缺氧 / 製造增加 ; Type B = 代謝問題
乳酸代謝主要是 liver (60%) and kidney (30%)
- 另外還有一種較少見的 D-lactic acidosis
多發生在 short bowel syndrome 病人中
Lactate 要特別想三個 : Cyanide, CO, Methanol
本院 : Lactate [乳酸] (mmol/l) = 0.5~2.2
( Septic shock 定義 : 18 mg/dL = 2 mmol/L )
during heavy exercise, the skeletal muscles contribute most of the much increased circulating lactate
during pregnancy, the placenta is an important producer of lactate (can pass to fetus as well)
lactate is metabolised predominantly in the liver (60%) and kidney (30%)
Type A : Tissue hypoxia and elevated lactate production
組織缺氧 / 製造增加
組織缺氧 / 製造增加
- Hypovolemia, sepsis, cardiopulmonary arrest,
cardiac failure, Regional hypoperfusion (Mesenteric ischaemia)
cardiac failure, Regional hypoperfusion (Mesenteric ischaemia)
- CO, Hypoxemia
- Generalized seizures
Type B : Normal tissue oxygenation,
impairment of lactate metabolism 代謝問題
impairment of lactate metabolism 代謝問題
B1: associated with underlying diseases
LUKE: leukaemia, lymphoma
TIPS: thiamine deficiency, infection, pancreatitis, short bowel syndrome
FAILURES: hepatic, renal, diabetic failures
B2: associated with drugs & toxins
biguanides (metformin)
cyanide
methanol, salicylates
ethanol intoxication in chronic alcoholics
linezolid
anti-retroviral drugs (HAART)
isoniazid
beta-agonists
adrenaline
nitroprusside infusion
B3: associated with inborn errors of metabolism
Med Data Speaks
[藥物安全] Metformin造成乳酸中毒的機轉
藥學人生 - Pharmalife
Linezolid 之藥物不良反應：乳酸中毒 (Linezolid-Induced Lactic Acidosis)
https://www.facebook.com/clinicalRx/posts/1162161667148344/
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