CICM SAQ 2010.1 Q24
Questions
A 33 year old female presented with high fever and abdominal pain. She has Gram negative bacteraemia and septic shock.
The following is data from a blood gas analysis:
- 24.1. List the acid-base abnormalities.
- 24.2. What are the causes of elevated plasma lactate in sepsis?
- 24.3. Name three (3) drugs (each from a different class of drugs) which result in plasma hyperlactaemia.
- 24.4. List two (2) inborn errors of metabolism associated with lactic acidosis.
Answers
Answer and interpretation
24.1. List the acid-base abnormalities.
- High anion gap metabolic acidosis with raised lactate
- Metabolic alkalosis ( Delta BE < Delta AG)
- Respiratory alkalosis
24.2. What are the causes of elevated plasma lactate in sepsis?
- Circulatory failure due to hypotension and hypoxia
- Microvascular shunting and mitochondrial failure (cytopathic hypoxia)
- Use of adrenaline as an inotrope
- Inhibition of pyruvate dehydrogenase (PDH) by endotoxin
24.3. Name three (3) drugs (each from a different class of drugs) which result in plasma hyperlactaemia.
- Catecholamines
- Metformin / Phenformin
- Alcohols
- Cyanide, nitroprusside
- Salicylates
- Lactate containing solutions – HRL, dialysates
- Iron
- Isoniazid
24.4. List two (2) inborn errors of metabolism associated with lactic acidosis.
- Glucose 6 phosphatase deficiency
- Fructose 1,6 diphosphatase deficiency
- Pyruvate carboxylase deficiency
- Deficiency of enzymes of oxidative phosphorylation
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