What do you do with a double digit lactate? Sepsis almost never gives you a lactate >10!
1) If Lactate is greater than 10 immediately think:
lab error
seizure
ischemia (necrosis, compartment syndrome, shock liver)
metformin toxicity
thiamine deficiency
toxic alcohols
cyanide toxicity
2) Isopropanol is the "weird one out" for toxic alcohols - it elevates osmolality gap, but NOT anion gap. It does not cause an acidosis (methanol, ethylene glycol WILL cause HAGMA)
Must know the above for board exams but in reality osmolality gap is not very useful
Serial anion gaps is more sensitive for toxic alcohols
3) If the lactate on the VBG or the ABG is much higher than serum lactate, this is known as LACTATE GAP
this is due to differences in the tests, but it is very specific for ETHYLENE GLYCOL poisoning
- Austin Parish