Lactic Acidosis: Causes, Symptoms, and Treatment

Lactic acidosis is commonly seen in people over 40. It is characterized by excessive amounts of lactic acid in the bloodstream due to oxygen deprivation. Although comorbidities such as liver, kidney, and heart diseases are strongly associated with lactic acidosis, trauma or adverse reaction to medication can also contribute to the development of lactic acidosis.

Key takeaways:

The current management of lactic acidosis is targeted toward treating the cause. Additional management strategies are unique to each patient's needs and health profile.

What is lactic acidosis?

Lactic acidosis is a medical condition characterized by high levels of lactic acid in the bloodstream. Lactic acidosis can occur due to the liver and kidneys’ inability to filter lactic acid from the blood and break it down into glucose, the body’s main energy source. However, it typically occurs when the body produces excessive amounts of lactic acid, than desired. Lactic acid is produced when the body generates energy anaerobically (i.e., without oxygen).

For instance, in normal circumstances, oxygen fuels muscle cells to generate energy. This is called an aerobic energy system. However, when the intensity of physical activity exceeds the supply of oxygen to the relevant muscles, the muscle cells will generate additional energy by breaking down glucose anaerobically. Lactic acid is a by-product of this process. Although lactic acid has severe adverse effects in high concentration, it serves several important body functions, including:

  • Energy regulation. Cells produce lactic acid to generate additional energy in the absence of oxygen during intense physical activity. Also, lactic acid filtered by the kidneys and liver is converted into glucose, the body's energy source.
  • Anti-inflammation. Lactic acid treatment reduces the production of pro-inflammatories and increases the production of anti-inflammatories in the body.
  • Wound healing. Lactic acid promotes tissue healing by enhancing the physiological processes involved in creating new body tissue.
  • Signaling. Lactic acid binds with various receptors and molecules in the body to facilitate or inhibit various physiological processes (e.g., wound healing).

Causes and risk factors for lactic acidosis

Lactic acidosis is caused by elevated levels of lactic acid in the blood due to several factors used to characterize the two types of lactic acidosis: type A and type B. Lactic acidosis type A is a common type resulting from an inadequate supply of oxygen to the blood tissue. On the other hand, lactic acidosis type B is a rare type resulting from altered metabolism by drugs or toxins. A diagnosis is confirmed when the blood PH and lactate levels are lower than 7.35 and higher than 5 mmol/L, respectively.

The common risk factors for lactic acidosis include:

  • Kidney disease
  • Sepsis
  • Liver disease
  • Heart failure
  • Uncontrolled diabetes
  • HIV treatment
  • Alcoholism

Signs and symptoms of lactic acidosis

No clinical features are unique to lactic acidosis. Therefore, thorough physical and blood examinations are required to confirm a diagnosis. The signs and symptoms associated with lactic acidosis include:

  • Dry skin and mouth
  • Severe hypotension
  • Confusion
  • Low urine output
  • Rapid and shallow breathing
  • Fever (>38.5 C)

Treatment options for lactic acidosis

First and foremost, you should schedule a medical check-up with a doctor if you are presenting with these signs and symptoms. To effectively manage lactic acidosis, the consulting doctor will identify and manage the specific cause of the condition. For example, having lactic acidosis due to sepsis means the doctor will take a targeted approach to managing sepsis. Since the causes of lactic acidosis are highly variable, the management thereof will also vary from patient to patient.

Nevertheless, the following management strategies are commonly used for people with lactic acidosis:

  • Antibiotics
  • Diet modification
  • Fluid replacement
  • Elimination of bodily toxins
  • Discontinuation of causative drugs
  • Vasoactive drugs
  • Debridement of a septic area
  • Dialysis for patients with severe kidney disease

It is unclear how prevalent lactic acidosis is, primarily because it usually affects hospitalized patients who are often too sick to be involved in clinical studies. However, it is known that people over the age of 40 are more likely to develop this condition. While the mortality rate is estimated at 5% in this patient group, new research is being conducted to develop effective strategies for preventing, managing, and preserving life.

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