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Lactic acids are often elevated in critical care patients (e.g. septic shock). It can be also elevated in setting of drug overdose or less frequently in therapeutic use due to interference of oxidative phosphorylation. Some of the agents include:
- Carbon monoxide
- Cyanide
- Propofol
- Metformin
- Propylene glycol
- Salicylates
- Beta-2 agonists
- Thiamine deficiency/alcoholic ketoacidosis
- Ethylene glycol/toxic alcohols
- Nucleoside reverse-transcriptase inhibitors
Bottom line:
- Although elevated lactic acid levels are often associated with underlying medical conditions, it is important to recognize drug-induced etiologies of lactic acidosis.
References
Kraut JA, Madias NE. Lactic acidosis, N Engl J Med 2014;371:2309-19.