lactic acidosis

What is Lactic Acidosis?

Lactic acidosis is a serious medical condition characterized by an excessive accumulation of lactate in the blood, leading to a state of metabolic acidosis. This occurs when the body's cells produce more lactate than they can metabolize, causing the pH levels in the blood to become too acidic.

Causes and Types

There are two main types of lactic acidosis: Type-A and Type-B. Type-A is caused by hypoperfusion and hypoxia, which occurs when there is a lack of oxygen supply to the tissues. Type-B is caused by an overproduction of lactate due to various factors such as diabetes, kidney disease, or certain medications.

Symptoms

The symptoms of lactic acidosis can vary depending on the severity of the condition. They may include:

• Abdominal pain
• Nausea and vomiting
• Diarrhea
• Fatigue
• Shortness of breath

Consequences

If left untreated, lactic acidosis can lead to serious complications such as:

• Respiratory failure
• Cardiac arrest
• Multi-organ failure

Prevention and Treatment

Preventing lactic acidosis involves managing underlying conditions such as diabetes or kidney disease. Treatment typically involves addressing the underlying cause, administering medications to correct the pH imbalance, and providing supportive care.

References:

• [1] Lactic acidosis occurs when lactate builds up in your blood and your pH levels become too acidic. It can be mild and transient, or severe... (Source: 1)
• [2-3] Type-A lactic acidosis is due to hypoperfusion and hypoxia, which occurs when an oxygen consumption/production ratio is disturbed. Lactate levels greater than 2 mmol/L represent hyperlactatemia, whereas lactic acidosis is generally defined as... (Source: 2-3)
• [4] Lactic acidosis begins when a person's body makes too much lactate and cannot metabolize it quickly enough. The condition can be a medical emergency. (Source: 7)
• [5-6] Lactic acidosis is a form of metabolic acidosis, a condition in which there's too much acid in the body. Lactic acidosis results from overproduction of lactate, decreased metabolism... (Source: 5-6)

Common Signs and Symptoms of Lactic Acidosis

Lactic acidosis, a serious medical condition characterized by an excessive accumulation of lactic acid in the body, can manifest through various symptoms. Understanding these signs is crucial for prompt diagnosis and treatment.

• Muscle-related symptoms: Muscle cramps or pain [1], muscle weakness [2], and overall feelings of physical discomfort [1] are common complaints among individuals with lactic acidosis.
• Cardiovascular symptoms: Low blood pressure [8], cool or clammy extremities [8], and decreased urination [8] can indicate a compromised cardiovascular system.
• Neurological symptoms: In severe cases, confusion, ataxia (loss of coordination), and slurred speech [3] may occur due to the buildup of lactic acid in the brain.
• Gastrointestinal symptoms: Nausea and vomiting [5], abdominal pain and discomfort [7], and a fruity-smelling breath [5] can be indicative of lactic acidosis.
• Generalized symptoms: Fatigue, exhaustion [1, 5], and overall body weakness [1, 7] are common complaints among individuals with this condition.

It is essential to note that the severity and presentation of these symptoms can vary depending on the underlying cause and individual factors. If you suspect lactic acidosis or experience any of these symptoms, seek medical attention immediately.

Diagnostic Tests for Lactic Acidosis

Lactic acidosis can be diagnosed through various blood tests that measure lactate levels and evaluate the acidity in the bloodstream. Here are some diagnostic tests used to diagnose lactic acidosis:

• Blood Lactate Test: This test measures the level of lactate in the blood, which is a key indicator of lactic acidosis.
• Comprehensive Metabolic Panel (CMP): A standard blood test that measures various factors in the blood to determine basic information about health. Blood lactate levels are specifically measured as part of this test.
• Arterial Blood Gas (ABG) Analysis: This test evaluates the pH level and acidity in the bloodstream, which is essential for diagnosing lactic acidosis.

These diagnostic tests help healthcare providers identify lactic acidosis and determine its severity. Early detection and treatment are crucial to prevent complications and improve patient outcomes.

References:

• [10] Tests to diagnose lactic acidosis include a comprehensive metabolic panel (CMP) and blood lactate test.
• [12] Lactic acidosis is diagnosed through three blood tests, including an arterial blood gas (ABG) revealing a pH level of less than 7.35.
• [13] Diagnostic tests for lactic acidosis include blood lactate levels and evaluation for acidity in the bloodstream.

Treatment Options for Lactic Acidosis

Lactic acidosis can be treated in various ways, depending on its severity and underlying cause.

• Mild cases: In mild cases, treatment may involve rest, hydration, and correction of any underlying medical conditions. [1]
• Hemodialysis: In severe cases, hemodialysis may be used to manage lactic acidosis, especially in patients with renal failure. However, this is not always effective, and the condition often persists despite treatment. [2]
• Sodium bicarbonate (NaHCO3): Sodium bicarbonate can be used to correct acidemia and improve symptoms in cases of D-lactic acidosis. Antibiotics may also be prescribed to decrease the number of organisms producing D-lactate. [3]
• Insulin therapy: Insulin therapy has been advocated for the treatment of some forms of lactic acidosis, particularly as a method of alleviating regional hypoperfusion. However, its effectiveness is still being researched and debated. [4]
• Bicarbonate therapy: Bicarbonate therapy may be used to correct acidemia in cases of lactic acidosis. However, its use should be carefully considered, as it can have adverse effects if not properly managed. [5]

Other Treatment Options

In addition to these specific treatments, the main treatment for lactic acidosis is often to correct the underlying medical problem that causes the condition. This may involve addressing issues such as hypovolemia or hypovolemic shock in adults. [6] In some cases, medications like epinephrine and albuterol may be used to treat related conditions, but their effectiveness in treating lactic acidosis itself is unclear. [7]

References

• [1] Jun 13, 2023
• [2] by CD Foucher · 2023 · Cited by 112
• [3] Sep 11, 2020
• [4] by A Warner · 1981 · Cited by 28
• [5] by M Wiederkehr · Cited by 9
• [6] Jun 18, 2024
• [7] Oct 25, 2022

Differential Diagnosis of Lactic Acidosis

Lactic acidosis is a serious medical condition characterized by an excessive accumulation of lactate in the blood, leading to metabolic acidosis. The differential diagnosis of lactic acidosis involves identifying the underlying causes of this condition.

Common Causes:

• Type A Lactic Acidosis: This type is caused by ischemia (reduced blood flow) and is more serious than Type B. It can be caused by conditions such as shock, cardiac arrest, or severe burns.
• Type B Lactic Acidosis: This type is caused by abnormalities in carbohydrate metabolism, medication use, or other factors that lead to increased lactate production.

Other Differential Diagnoses:

• Alcoholic Ketoacidosis: A condition characterized by the accumulation of ketones and lactic acid in the blood due to excessive alcohol consumption.
• Anemia: A condition where the body does not have enough red blood cells or hemoglobin, leading to inadequate oxygen delivery to tissues.
• Bacterial Sepsis: A life-threatening infection that can cause metabolic acidosis and lactic acidosis.
• Distributive Shock: A type of shock characterized by vasodilation (widening of blood vessels) and decreased blood pressure.
• Hemorrhagic Shock: A condition where there is significant blood loss, leading to inadequate oxygen delivery to tissues.

Key Points:

• Lactic acidosis can be caused by various factors, including ischemia, abnormalities in carbohydrate metabolism, medication use, and other conditions.
• Type A lactic acidosis is more serious than Type B and requires immediate attention.
• Other differential diagnoses include alcoholic ketoacidosis, anemia, bacterial sepsis, distributive shock, and hemorrhagic shock.

References:

• [8] Mar 26, 2024 - Lactate levels greater than 2 mmol/L represent hyperlactatemia, whereas lactic acidosis is generally defined as a serum lactate concentration >5 mmol/L.
• [10] This has a relatively narrow differential diagnosis: Lab artefact / incorrect electrolyte measurement. Lactic acidosis. Ketoacidosis (e.g., starvation or diabetic ketoacidosis). Most other causes of elevated anion gap either cause slower shifts (e.g., uremia) or are unlikely to occur in the hospital (e.g., overdose).
• [13] 3.1 Lactate in health. Lactate (C3H6O2) is produced from pyruvate during glycolysis as part of the metabolism of glucose for energy.