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Type B Lactic Acidosis

Tuesday, October 8, 2013 13:04

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Nice case report in AJKD recently raised the issue of Type B Lactic Acidosis. Lactic acidosis occurs when there is excessive anaerobic glycolysis or decreased removal of lactate from the circulation. Classically, Type A lactic acidosis is related to tissue hypoperfusion resulting in an increase in anaerobic glycolysis. Type B lactic acidosis occurs despite the presence of sufficient oxygen for aerobic glycolysis. There are a number of important causes:

Drugs/Toxins	Metformin Linezolid Propofol Nucleoside Reverse Transcriptase Inhibitors Salicylates Isoniazid Alcohol Cyanide
Enzyme Deficiencies	Glucose-6-phosphatase Pyruvate carboxylate Pyruvate Dehydrogenase Oxidative Phosphorylation Defects
Other Disorders	Kidney Failure Liver Failure Thiamine Deficiency Malignancy

The case report in AJKD was a patient with myeloma who developed a severe lactic acidosis. The preference of tumor cells for anaerobic glycolysis has been known since the 1920s and is called the Warburg Effect. It is thought to be due to a combination of increased IGF and TGF-alpha production by tumor cells and thiamine deficiency which is common in patients with malignancies. The discussion in the case report gives a nice summary of the literature.

Source: http://renalfellow.blogspot.com/2013/10/type-b-lactic-acidosis.html

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