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.
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.
- Metformin / Phenformin
- Cyanide, nitroprusside
- Lactate containing solutions – HRL, dialysates
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
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.