Table 1.
Drugs Induced Lactic Acidosis.
| Lactate Classification |
Mechanism | Medication | Treatment |
|---|---|---|---|
| Tybe A | Reduced Cardiac Output |
Clozapine, Diltiazem, Nifedipine, Procainamide | Medication Withheld Supportive Treatment Iniatiated |
| Type B-1 | Drug Induced Disease | Hepatic Failure (Acetaminophen, Erlotinib, Fludarabine) Mesenteric Ischemia (Canaglifozin) Gastrointestinal Ischemia (Epinephrine) Pancreatitis (Cimetidine, Exetanide, Rifampin, Isoniazid, Pyrazinamide, Ethambutol) Acute Kidney Injury (Exetanide, Ibuprofen, NSAID) Hemolytic Anemia (Sulfamethoxazole and Trimethoprim, Nitrofurantoin) Rhabdomyolysis (ralgtegravir) Hypoxiemia (Opioids) |
Medication Withheld Antidotes Administered If Applicable Supportive Treatment Initiated |
|
Type B-2
Related to Metabolism Impairment |
Increased Pyruvate Production | Albuterol, Metaproterenol, Salmeterol, Sorbitol, Caffeine, Theophylline, Epinephrine, Terbutaline | Medication Withheld AntidotesAdministered If Applicable Supportive Treatment Initiated |
| Alterations in Glucose Metabolism Favoring Accumulation of Lactate Relative to Pyruvate |
Ethanol, Niacin, Oxaliplatin, Streptozocin | Medication Withheld Supportive Treatment Initiated |
|
| Propylene Glycol excipient |
Diazepam, Lorazepam, Etomidate, Pentobarbital, Sulfamethoxazole and Trimethoprim, Nitroglycerin | Medication Withheld Supportive Treatment Initiated |
|
|
Type B-2
related to mitochondrial impairment |
Inhibition of Mitochondrial Protein Synthesis/Function |
Acetaminophen, Carboplatin, Linezolid, Simvastatin, Minocycline, Telbivudine, Adefovir, Entecavir, Linezoild | Medication Withheld Supportive Treatment Initiated |
| Inhibition of Mitochondrial Electron Transport Chain |
Clozapine, Propofol, Sodium Nitroprusside, Valproate, Venlafaxine | Medication Withheld Supportive Treatment Initiated |
|
| Mitochondrial Toxicity |
Ganciclovir, Valanciclovir, Ribavirin-Sofosbuvir, Adasabuvir.Ombitasvir, Paritaprevir, Ritonavir | Medication Withheld Supportive Treatment Initiated |
|
| Uncoupling Oxidative Phosphorylation | Sulfasalazine, Metformin | Medication Withheld Supportive Treatment Initiated |
|
| Type D | Bacterial Overgrowth in Setting of Short Bowel Syndrome | Doxycicline, Sulfamethoxazole and Trimethoprim | Medication Withheld Supportive Treatment Initiated |