Figure 620

Conventionally, two broad types of lactic acidosis are recognized. In type A, clinical evidence exists of impaired tissue oxygenation. In type B, no such evidence is apparent. Occasionally, the distinction between the two types may be less than obvious. Thus, inadequate tissue oxygenation can at times defy clinical detection, and tissue hypoxia can be a part of the pathogenesis of certain causes of type B lactic acidosis. Most cases of lactic acidosis are caused by tissue hypox-ia arising from circulatory failure [14,15].

> Cause-specific measures

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No

Circulatory failure?

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• Preload and afterload reducing agents

• Myocardial stimulants (dobutamine, dopamine)

• Avoid vasoconstrictors

• Volume repletion

• Preload and afterload reducing agents

• Myocardial stimulants (dobutamine, dopamine)

• Avoid vasoconstrictors

• Antibiotics (sepsis)

• Discontinuation of incriminated drugs

• Glucose (hypoglycemia, alcoholism)

• Operative intervention (trauma, tissue ischemia)

• Thiamine (thiamine deficiency)

• Low carbohydrate diet and antibiotics (D-lactic acidosis)

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