HYPERLACTATAEMIA. Aetiology

Anaerobic causes

◆ Macrocirculatory shock.
◆ Microcirculatory shunting.
◆ Carbon monoxide poisoning (carboxyhaemoglobin).

Aerobic causes

◆ Increased aerobic glycolysis:
    • Catecholamine-stimulated increased Na+–K+-pump activity.
    • Cytokine-mediated glucose uptake.
◆ Mitochondrial dysfunction.
◆ Pyruvate dehydrogenase dysfunction:
    • Sepsis.
    • Thiamine deficiency.
◆ Reduced clearance:
    • Liver insufficiency/surgery.
    • Sepsis.
◆ Alkalosis.
◆ Malignancy (Warburg effect).
◆ Epileptic seizure (grand mal).
◆ Congenital metabolic diseases.
◆ Drugs and intoxications:
    • Nucleoside reverse transcriptase inhibitors.
    • Epinephrine.
    • Metformin.
    • Propofol (propofol infusion syndrome).
    • Corticosteroids.
    • Cyanide.
    • Ethylene glycol.
    • Methanol.
    • Carbon monoxide poisoning (inhibition of cytochrome

      oxidase).