Alcohol/Starvation-induced keto-acidosis & Lactic acidosis Flashcards
what is a typical presentation of alcohol-induced keto-acidosis
older patient, heavy alcohol intake for many years, abdo pain, vomiting,
what is typically seen on examination of alcohol-induced keto-acidosis
dry and difficult to rouse, hypotensive, tachypnoeic
what biochemical markers are raised in alcohol/starvation-induced keto-acidosis
lactate, ketones, anion gap
what biochemical markers are low in alcohol/starvation-induced keto-acidosis
pH, bicarbonate, glucose may be low(usually normal)
describe the levels of dehydration in alcohol/starvation-induced keto-acidosis, and in lactic acidosis
alcohol/starvation = very dehydrated dehydrated
lactic acidosis = no dehydration
what is the normal range for lactate
o.6 to 1.2mmol/l
in what states is lactate levels low and raised
lowest in fasted state
raised in exercise, can be high as 10mmol/l
what is the normal range of the anion gap, and what is it useful for
10-18mmol/l, useful in determining cause of acidosis
what is the anion gap
(Na+ + K+) - (HCO3- + Cl-)
what is the difference between hyperlactataemia and lactic acidosis
both have high lactate but pH <7.3 in lactic acidosis
what is type A of lactic acidosis associated with
hypoxaemia, eg infarcted tissue, cardiogenic shock, sepsis, haemorrhage etc.
what is type B of lactic acidosis associated with
liver disease, leukaemic states, diabetes
what are some of the clinical features of lactic acidosis
hyperventilation, mental confusion, stupor or coma if severe
what lab findings are seen in lactic acidosis
reduced bicarbonate, raised anion gap, absence of ketones, raised phosphate pH low, glucose variable(often high)
what is involved in the management of lactic acidosis
treat underlying cause, fluids, antibiotics, withdraw offending medication
