Lactic Acidosis (+ Anion Gap)

Your Path

  • Lactic acidosis (+ anion gap)


  • Hypotension and end organ hypo-perfusion
  • Often associated with low SVR (e.g. sepsis), decreased preload (e.g. hypovolemia for any reason), impaired isotropy (ischemic or idiopathy cardiomyopathy), or heart rhythm problems (bradycardia, SVT)
  • Patients typically quite sick
  • Meds including metformin in setting ckd


  • Weak, confused, decreased level of consciousness (impaired perfusion)
  • Focal symptoms based on cause of hypo perfusion (e.g. fever, sob, sputum if from pneumonia; vomiting blood if from acute anemia related to variceal bleeding, etc)

Physical Exam Findings

  • Low BP
  • Often ill appearing
  • Confused or decreased level of consciousness
  • Extremities can be warm (low SVR, distributive shock) or cool (hypovolemia, cardiogenic)
  • Other focal findings based on etiology (e.g. ascites, jaundice, other features portal hypertension if variceal bleeding; etc)