This is the podcast, ICU rounds.

My name is Dr. Jeffrey Guy.

I'm an associate professor of surgery and director at the Burns Center at the Vanderbilt University of School of Medicine in Nashville, Tennessee.

Welcome back to ICRounds.

The topic we're going to pick up today is the discussion of what a type B lactic

acidosis is.

Now, remember in the last podcast, we talked about a type A lactic acidosis.

We got into discussion that a cell requires oxygen to basically for its metabolism.

And so glucose will then go through glycolysis and in normal conditions end up going through the

Krebs cycle or some they know as the citric acid cycle and then go through the process

of the electron transport chain.

And some people will also refer to as oxidative phospholation.

However, this process requires oxygen,

and there are circumstances, clinical circumstances that occur when there isn't enough oxygen.

Now, this occurs in circumstances where the oxygen delivery does not meet or exceed the

oxygen demand of a particular cell or tissue.

When this occurs, glucose will then go to pyruvate, however, pyruvate cannot enter the

crib cycle.

That pyruvate is then converted to lactate and then eventually up to the core cycle.

We get the creation of what we call lactagacidosis.

Now, under most clinical circumstances, we use that elevation of the lactate

as a biomarker for shock. And it's important to remember that we keep hammering home that shock

...