Lactic acidosis and acute ethanol intoxication

“…Although ethanol may increase lactate levels in an experimental setting, clinically significant elevated lactate is rare in patients with no other complaints or co-morbidities. 127–129 Ruling out and treating other causes of severely elevated lactate in these patients are therefore important and lactate elevation should not solely be attributed to the potential effects of ethanol. Ethanol-intoxicated patients might be at increased risk for other causes of elevated lactate such as thiamine deficiency, seizures, sepsis, and other toxins.…”

Section: Etiologies Of Elevated Lactatementioning

confidence: 99%

Etiology and Therapeutic Approach to Elevated Lactate Levels

Andersen

Mackenhauer

Roberts

et al. 2013

Mayo Clinic Proceedings

531

444

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Lactate levels are commonly evaluated in acutely ill patients. Although most commonly used in the context of evaluating shock, lactate can be elevated for many reasons. While tissue hypoperfusion is probably the most common cause of elevation, many other etiologies or contributing factors exist. Clinicians need to be aware of the many potential causes of lactate elevation as the clinical and prognostic importance of an elevated lactate varies widely by disease state. Moreover, specific therapy may need to be tailored to the underlying cause of elevation. The current review is based on a comprehensive PubMed search and contains an overview of the pathophysiology of lactate elevation followed by an in-depth look at the varied etiologies, including medication-related causes. The strengths and weaknesses of lactate as a diagnostic/prognostic tool and its potential use as a clinical endpoint of resuscitation will be discussed. The review ends with some general recommendations on management of patients with elevated lactate.

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“…20,21 Thiamine supplementation may be partially useful in cases with alcohol overdose. 22 Reassessment for unrecognized causes is warranted in all cases of persistent lactate elevation despite therapy. 16 In the absence of hypotension, hypoxemia, kidney or liver dysfunction, myopathy, malignancy, or use of other medications known to be associated with lactic acidosis, venlafaxine was the likely cause of lactic acidosis in our case.…”

Section: Discussionmentioning

confidence: 99%

Type B Lactic Acidosis Associated With Venlafaxine Overdose

Iragavarapu

Gupta

Chugh

et al. 2016

American Journal of Therapeutics

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Lactic acidosis that is not secondary to tissue hypoperfusion or hypoxemia (type B lactic acidosis) is a rare but potentially fatal condition that has been associated with drugs like metformin, linezolid, and nucleoside reverse-transcriptase inhibitors in patients with HIV. We report the first case of type B lactic acidosis caused by overdose of the serotonin-norepinephrine reuptake inhibitor, venlafaxine. A 55-year-old man with no significant medical history was brought to the emergency department after intentional ingestion of around 80 capsules of venlafaxine (a total dose of over 6000 mg) in an attempt to commit suicide. Complete blood count and comprehensive metabolic panel were unremarkable except for a bicarbonate level of 13 mEq/L and an anion gap of 22 mEq/L. An arterial blood gas revealed a pH of 7.39, partial pressure of CO2 of 19 mm Hg, calculated bicarbonate of 11.5 mEq/L, and a lactate level of 8.6 mmol/L. The patient was started on aggressive intravenous hydration with normal saline along with oral activated charcoal with sorbitol. Repeat laboratory work after 4 hours showed an improvement in anion gap (15 mEq/L) and serum lactate (5.6 mmol/L). The patient remained stable throughout the hospital stay and lactic acidosis resolved in 24 hours. In the absence of hypotension, hypoxemia, kidney or liver dysfunction, myopathy, malignancy, or use of other medications, venlafaxine was the most likely cause of lactic acidosis in our case. Rapid improvement of acidosis was probably related to clearance of the drug.

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Lactic acidosis and acute ethanol intoxication

Cited by 38 publications

References 32 publications

Lactate as a diagnostic marker in transient loss of consciousness

Lactate as a diagnostic marker in transient loss of consciousness

Etiology and Therapeutic Approach to Elevated Lactate Levels

Type B Lactic Acidosis Associated With Venlafaxine Overdose

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