A diabetic normotensive patient of Enterococcus faecalis sepsis, on intravenous Linezolid developed high anion gap metabolic acidosis with increased serum lactate and negative ketone. The acid base abnormality is most probably?
The given case is of high anion gap metabolic acidosis with increased serum lactate and negative ketones. This rules out choice B and C. Lactic acidosis of type A variety occurs due to poor tissue perfusion and occurs due to Shock or cardiac failure Severe Anemia Mitochondrial enzyme defects Carbon monoxide poisoning, Cyanide poisoning Lactic acidosis of type B occurs due to Malignancies Diabetes Mellitus Renal or hepatic failure Thiamine deficiency Severe Infections (Cholera, Malaria) Seizures Drugs/toxins (biguanides, ethanol, methanol, propylene glycol, isoniazid, and fructose and Nucleoside analogue reverse transcriptase inhibitors in HIV and linezolid) Extra edge Enterococcus Endocarditis E. faecalis >>E.faecium Resistant to many antimicrobial agents Rx--Combination of b-lactam antibiotics with aminoglycoside -Synergistic and bactericidal effects
Type A lactic acidosis due to septic shock
Metabolic acidosis of unceain etiology
Diabetic ketoacidosis
Type B lactic acidosis due to linezolid
Diabetes Mellitus