Causes of Lactic acidosis are classically divided into 2 types by the Cohen & Woods classification based upon the presence or absence of an oxygen demand/delivery mismatch:
Type A: Oxygen Demand / Delivery Mismatch
(Anaerobic respiration as a result of tissue hypoxia)
(Anaerobic respiration as a result of tissue hypoxia)
- Hypoperfusion (septic shock, cardiogenic shock, hypovolaemic/haemorrhagic shock, obstructive shock)
- Hypoxaemia
- Severe anaemia
- Carbon monoxide poisoning
- Seizures / convulsions
- Shivering
- Exercise
- Hyperthermia
Type B: No Oxygen Demand / Delivery Mismatch
Type B1: Associated with underlying disease
- Liver disease
- Thiamine deficiency
- Leukaemia
- Lymphoma
- AIDS
Type B2: Associated with drugs and toxins
- Cyanide
- Metformin
- Beta-agonists
- Methanol
- Propofol (PRIS)
- Nitroprusside infusion
- Ethanol intoxication in chronic alcoholics
- Anti-retroviral drugs
Type B3: Associated with inborn errors of metabolism
- Congenital enzyme defects (e.g. pyruvate dehydrogenase deficiency)