|
| | Group | Mechanism | Condition/disease | Expected finding |
|
| A (increased lactate production) | Low global oxygen delivery leading to excessive anaerobic glycolysis | Severe hypoxia | Any cause (pO2 < 4 kPa) | High pCO2 gap fluids and ↑ cardiac output are likely to help |
| Low O2 transport capacity | CO poisoning |
| Severe anaemia |
| Low cardiac output = hypodynamic shock | Low preload (hypovolaemia) |
| Low contractility (cardiogenic) |
| High afterload (obstructive) |
| Normal or high cardiac output, but demand even higher | Strenuous exercise | Fluids and ↑ cardiac output may or may not help |
| Shivering or seizures |
| Local ischaemia leading to excessive anaerobic glycolysis | Inflow occlusion | Limb ischaemia |
| Mesenteric ischaemia |
| Decreased perfusion pressure | Compartment syndromes |
| Local ischaemia (Wartburg effect) | Cancer |
| Increased glycolysis in the presence of enough oxygen | Stimulation of muscle and liver glycogenolysis | Beta-2-mimetics | Low pCO2 gap fluids and ↑ cardiac output likely to cause harm |
| Adrenalin (exogenous or excessive stress) |
| Electrical muscle stimulation [1] |
| Cocaine |
| Theophylline |
| Blocked oxidative phosphorylation (cytopathic hypoxia) | Metformin |
| Cyanide poisoning |
| Propofol-infusion syndrome |
| Methanol |
| Ethylene glycol |
| Production of L- and D-lactate by colon bacteria | Short bowel + |
| B (decreased lactate uptake) | Decreased lactate uptake | Liver failure | Acute liver failure |
| Liver ischaemia |
| Failed conversion of pyruvate to AcCoA | Thiamine deficiency |
| Failed conversion of lactate to pyruvate | Alcohol intoxication |
|
| Mixed | Sepsis | Element of hypoxia, aerobic glycolysis, and splanchnic ischaemia | Complex condition |
| Propylen glycol poisoning | Mix of D- and L-lactate overproduction and element of oxidative phosphorylation block |
|
