Diagnosis of Lactic Acidosis
Lactic Acidosis Diagnosis: Book Excerpts
Diagnostic Tests for Lactic Acidosis: Online Medical Books
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LACTIC DEHYDROGENASE ELEVATION:
Ask the Following Questions:
(Algorithmic Diagnosis of Symptoms and Signs)
- What is the level of
creatine phosphokinase isoenzyme containing M and B subunits (MB-CPK)
? An elevated MB-CPK combined with elevated LDH is most likely due to a myocardial infarction, although myocarditis and pericarditis can produce a similar picture.
- What is the AST level? If the MB-CPK or CPK are not also increased, an elevation of both the LDH and AST would point to liver disease.
- What are the serum and urine creatine levels? If these are elevated, muscle disease must be considered likely.
- What does the lung scan show? If positive,
a lung scan
separates pulmonary infarction from the other conditions in this group.
DIAGNOSTIC WORKUP
The diagnostic workup should include a CBC, urinalysis, chemistry panel, sedimentation rate, ANA, urine and serum creatine, urine myoglobin, serial EKGs, blood gas analysis, LDH isoenzymes, chest x-ray, lung scan, EMG, and cardiology and neurology consults. A liver scan, CT scan of the abdomen and liver, and muscle biopsy may be necessary.
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Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
ASPARTATE AMINOTRANSFERASE, ALANINE AMINOTRANSFERASE, AND LACTIC DEHYDROGENASE ELEVATION:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
Obviously, the first condition to rule out is myocardial infarction. This is done by ordering serial MB-CPKs (MB isoenzyme of creatine phosphokinase) and ECGs. Serum cardiac troponin levels may also be helpful. Next, determine if the patient is on heparin, because this may elevate the alanine aminotransferase (ALT) level. Various muscle diseases (dermatomyositis, muscular dystrophy, muscle trauma, etc.) may be excluded by ordering CPK enzymes also, particularly the MM (MM isoenzyme of creatine phosphokinase) fraction. Liver disease can be revealed through by a liver profile, CT scan of the abdomen, and gallbladder ultrasonography.
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Source: Differential Diagnosis in Primary Care, 2007
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