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?: (A) Type A lactic acidosis due to septic shock, (B) Metabolic acidosis of unceain etiology, (C) Diabetic ketoacidosis, (D) Type B lactic acidosis due to linezolid
Answer is D. 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