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What to know about lactic acidosis

Date: Feb-09-2018
  1. Symptoms
  2. Causes
  3. Treatments
  4. Complications
  5. Types
  6. Diagnosis
  7. Prevention
Lactic acidosis occurs when the body produces too much lactic acid and cannot metabolize it quickly enough. The condition can be a medical emergency.The onset of lactic acidosis might be rapid and occur within minutes or hours, or gradual, happening over a period of days. The best way to treat lactic acidosis is to find out what has caused it.Untreated lactic acidosis can result in severe and life-threatening complications. In some instances, these can escalate rapidly.
Fast facts on lactic acidosis:
  • It is not necessarily a medical emergency when caused by over-exercising.
  • The prognosis for lactic acidosis will depend on its underlying cause.
  • A blood test is used to diagnose the condition.

What are the symptoms?

Lactic acidosis symptoms that may indicate a medical emergency include a rapid heart rate and disorientaiton.

Typically, symptoms of lactic acidosis do not stand out as distinct on their own but can be indicative of a variety of health issues.

However, some symptoms known to occur in lactic acidosis indicate a medical emergency.

These include:
  • disorientation
  • yellow skin or eyes, known as jaundice
  • shallow, rapid, or other breathing problems
  • rapid heart rate
Other symptoms include:
  • muscle pains or cramping
  • overall body discomfort
  • abdominal pain and discomfort
  • body weakness
  • fatigue, lethargy, and unusual sleepiness
  • reduced appetite problems
  • diarrhea
  • nausea and vomiting
  • headaches
Any of these symptoms could mean a life-threatening situation, and anyone who experiences one or more should call 911 or go to an emergency room right away.

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What are the causes?

The most common causes of lactic acidosis are:
  • cardiogenic shock
  • hypovolemic shock
  • severe heart failure
  • sepsis
  • severe trauma
Other causes of lactic acidosis include:
  • kidney conditions
  • liver disease
  • diabetes mellitus
  • HIV treatments
  • extreme physical exercise
  • alcoholism

Kidney conditions

Lactic acidosis can occur in people whose kidneys are unable to get rid of excess acid.

Even when not related to just a kidney condition, some people's bodies make too much lactic acid and are unable to balance it out.

Diabetes mellitus

Diabetes increases the risk of developing lactic acidosis.

Lactic acidosis may develop in people with type 1 and 2 diabetes mellitus, especially if their diabetes is not well controlled.

There have been reports of lactic acidosis in people who take metformin, which is a standard non-insulin medication for treating type 2 diabetes mellitus. However, the incidence is low, with equal to or less than 10 cases per 100,000 patient-years of using the drug, according to a 2014 report in the journal Metabolism.

The incidence of lactic acidosis is higher in people with diabetes who also have other conditions, such as congestive heart failure and kidney disease. For these people, lactic acidosis indicates a poor prognosis.

One 2015 report highlighted the case of 49-year-old man with type 2 diabetes mellitus and congestive heart failure who arrived at an emergency department with difficulty breathing. Within a couple of hours, he developed severe metabolic acidosis with high lactate concentrations. The man probably had lactic acidosis upon arrival to the hospital, which then quickly escalated.

The man's daily metformin prescription was changed to the maximum allowed a few weeks before his admission to hospital.

Metformin was determined to be the potential cause of his lactic acidosis, taking into account his comorbid diseases, his health when he arrived at the hospital, and medication he was prescribed beforehand.

HIV treatments

Lactic acidosis can be a serious complication of antiretroviral therapy that prevents the replication of HIV.

Antiretroviral treatments make it harder for the body to stay within a normal level of lactate acid, so those people taking some antiretroviral therapies for HIV are at a higher risk for lactic acidosis.

Exercise

In cases of people who are healthy, lactic acidosis can happen after strenuous physical exercise.

In these cases, the condition is temporary and is the result of the body needing more oxygen to keep up with the amount of lactate building up in the blood.

When this mismatch occurs during intense exercise, symptoms may include a burning feeling in the muscles, nausea, and weakness.

Alcoholism

There has been evidence connecting excessive alcohol consumption to a subtype of lactic acidosis called alcohol associated lactic acidosis.

A higher incidence of this type of lactic acidosis is linked to people who are critically ill, including those with sepsis, which is often a life-threatening complication of infection.

Treatment options

Lactic acidosis can be halted by treating the underlying cause, potentially allowing a lactic acid excess to be metabolized.

While a doctor is trying to find the underlying cause of lactic acidosis, or if the exact cause cannot be immediately found, treatments are given to support oxygen delivery and circulation.

Treatments can include:
  • intravenous fluid to promote circulation
  • oxygen, delivered with a face mask or another way
  • positive pressure ventilation to deliver oxygen to the lungs
  • vitamin therapy
  • hemodialysis with bicarbonate
Individuals who experience lactic acidosis while exercising can stop what they are doing, rehydrate by drinking water, and rest.

For some people, lactic acidosis is a temporary condition that can be treated successfully. For others, treatment may be complicated if lactic acidosis is part of other health conditions. Then, successful treatment will depend on management of their other health complications.

Complications

Complications may be prevented by managing underlying medical conditions correctly.

Complications of untreated lactic acidosis include:
  • irregular heart rhythm
  • unconsciousness or coma
  • shock
  • major organ failure
The risk for complications can be minimized by an individual keeping any underlying medical conditions stable with correct treatments.

Types of lactic acidosis

Lactic acidosis is divided into two types:

Type A

Type A lactic acidosis is related to tissue hypoxia where the body is deficient in oxygen. It is also a characteristic of critical illness, such as sepsis and septic shock, or acute medical disease states, including those involving the cardiovascular system and liver.

Type A also includes exercise-induced lactic acidosis, due to an increased oxygen requirement.

Type B

Type B lactic acidosis is not related to tissue hypoxia and can be due to health conditions, such as renal disease and certain cancers.

Type B is linked to the use of some medications, including those for treating type 2 diabetes mellitus and HIV.

Chronic alcoholism and chronic liver disease can also be causes of type B lactic acidosis.

Diagnosis

A diagnosis of lactic acidosis can be confirmed by checking the lactate level in the blood. These levels will be above normal when someone has lactic acidosis.

Other laboratory tests can also be done to determine the cause or causes of lactic acidosis, as well as to identify other potential dysfunction within the body.

Blood samples are usually from a vein but may sometimes be taken from an artery.

Prevention

Prevention of lactic acidosis is possible by managing its potential causes.

Anyone with diabetes mellitus, HIV, heart failure, liver disease, or kidney problems should work with their doctor to manage their conditions and take all medications as prescribed.

Anyone who experiences adverse reactions to diabetes or HIV medications should tell their doctor immediately.

Keeping hydrated, balancing resting and working out, and avoiding strenuous activity when not feeling well, can help avoid exercise-induced lactic acidosis.

Lastly, it is important not to abuse alcohol. Anyone with alcohol concerns should seek help from family, friends, their doctor, a therapist, or through a rehabilitation 12-step program.

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Courtesy: Medical News Today
Note: Any medical information available in this news section is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional.