Lactic acidosis


Appropriate Tests


Blood gas arterial; L-Lactate, Electrolytes, Urea, Creatinine; Hydroxybutyrate if ketoacidosis also suspected; Urate.

Shock, including

  • Sepsis
  • Hypovolaemia

See Septicaemia

Asphyxia, including

  • Grand mal fits


Heart failure (severe)

See Cardiac failure

Drug toxicity, including


  • Metformin toxicity


  • Salicylate toxicity

Salicylate. See Drug assays - therapeutic drug monitoring.

  • Ethanol toxicity

Ethanol level.

Hepatic failure


Genetic (without hypoglycaemia)

  • Mitochondrial disorders
  • Pyruvate dehydrogenase deficiency

Pyruvate. Muscle biopsy - histology; Enzyme assays and Molecular genetics - consult pathologist before biopsy.

Genetic (with hypoglycaemia)

  • Type l glycogen disease

Glucose, Pyruvate. Liver biopsy with histology, Enzyme studies, Glycogen - consult pathologist before biopsy.

D-lactic acidosis

  • Bowel bacterial overgrowth

D-lactate - consult pathologist.

Respiratory alkalosis

The associated, compensatory, metabolic acidosis often includes elevation of plasma lactate. See Alkalosis


Prolonged storage of blood at room temperature before separation. See Table 1.