UMEM Educational Pearls

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Title: Type B Lactic Acidosis

Category: Critical Care

Posted: 4/13/2010 by Mike Winters, MBA, MD (Updated: 3/3/2026)

Type B Lactic Acidosis

In the critically ill, patients may often have elevated lactate levels without ongoing tissue hypoperfusion.
In these patients it is important to consider the causes of what is referred to as "Type B Lactic Acidosis".
Pertinent to critically ill ED patients, consider the following:
- Type B1 - related to underlying disease
  - renal faiilure
  - hepatic failure
  - malignancy
  - HIV
- Type B2 - effects of drugs/toxins
  - acetaminophen
  - alcohols
  - beta-adrenergic agents: epinephrine
  - cocaine, methamphetamine
  - propofol
  - salicylates
  - valproic acid
  - metformin
- Type B3 - inborn errors of metabolism

Vernon C, LeTourneau JL. Lactic acidosis: Recognition, kinetics, and associated prognosis. Crit Care Clin 2010; 26:255-83.