Lactic Acidosis: Symptoms, Causes, Treatment and What to avoid

Your body is constantly working to keep itself in a state of balance. 

The great thing is that you don’t have to do anything to maintain this balance, like many of your body’s automatic functions. 

However, you’ll likely know when this delicate balance is disrupted. 

Lactic acidosis is a condition when lactate levels in your blood increase too much. 

Too much lactate causes lactic acidosis, which results in several symptoms to help notify you that something is wrong.

What is lactic acidosis?

Lactic acidosis is a condition where lactate levels build up in your bloodstream. Lactic acid is produced when the oxygen levels in your cells drop. 

The most common causes of lactic acidosis are serious health conditions that cause very low blood pressure and reduced oxygen delivery throughout your body.

There are two types of lactic acid – L-lactate and D-lactate. Most forms of lactic acidosis are caused by too much L-lactate. There are also two types of lactic acidosis – type A lactic acidosis and type B lactic acidosis.

Type A lactic acidosis is caused by tissue hypoperfusion. Hypoperfusion is when you have reduced blood flow to your body’s tissues. This can happen if you have heart failure, sepsis, or if you lose a large amount of blood.

Type B lactic acidosis isn’t caused by hypoperfusion and is rarer than type A lactic acidosis. Certain drugs like metformin can cause type B lactic acidosis, as can thiamine deficiency in alcoholics. 

Less seriously, you can develop temporary lactic acidosis by exercising too intensely or if you have a seizure.

Some health conditions and diseases that can cause lactic acidosis include:

  • AIDS

  • Alcoholism and/or thiamine deficiency 

  • Cancer

  • Cirrhosis

  • Cyanide poisoning

  • Kidney failure

  • Respiratory failure

  • Sepsis, a type of severe infection

It’s also possible to have congenital lactic acidosis, meaning you’re born with it. Pyruvate carboxylase deficiency causes lactic acid levels to accumulate in the blood and cause lactic acidosis. Untreated lactic acidosis can lead to damage to your body’s organs.

Normally your body regulates your pH level very well, but disruptions in pH can occur. Metabolic acidosis is a condition where your body’s acidity is too high. The most common cause of metabolic acidosis in hospitalized patients is lactic acidosis. 

Lactic acidosis and diabetes

Lactic acidosis is most commonly associated with metformin, a common diabetes medication. This is because lactic acidosis is a very rare potential side effect of taking metformin.

Metformin overdose is the main risk factor for developing lactic acidosis. According to a position statement in the American Diabetes Association: “When metformin is used as labeled, the increased risk of lactic acidosis is either zero or so close to zero that it cannot be factored into ordinary clinical decision making.” This means that it’s very safe to take metformin to treat your diabetes.

If you have severe renal impairment or kidney disease, you might be at greater risk of developing lactic acidosis because your kidneys can’t clear the lactic acid from your system. Your healthcare provider will consider this when prescribing your diabetes medications.

Metformin is safe to use when your estimated glomerular filtration rate (GFR) is greater than or equal to 45 milliliters per minute. The GFR is an indicator of how efficiently your kidneys filter blood. 

A GFR greater than 60 mL/minute is considered normal, and kidney failure occurs when the GFR falls below 15.

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10 symptoms of lactic acidosis

1. Abdominal discomfort

Abdominal pain is a common symptom in people with diabetic ketoacidosis (DKA) and lactic acidosis. Diabetic ketoacidosis occurs when insulin levels are very low, and blood sugar levels increase to dangerously high levels. 

Patients with uncontrolled type 1 diabetes are prone to getting DKA which is a potentially serious condition that requires prompt medical treatment.

2. Nausea

Nausea is a common symptom of lactic acidosis, though the exact reason why it occurs isn’t clear.

3. Decreased appetite

You might have a decreased appetite due to the abdominal pain and nausea that lactic acidosis can cause. 

4. Diarrhea 

Diarrhea can cause certain types of acidosis but is also a possible symptom of lactic acidosis. Chronic diarrhea causes you to lose bicarbonate which helps control your body’s pH level. This can lead to hyperchloremic acidosis, another type of acidosis.

5. Fast, shallow breathing

When your body’s acid level increases, your respiratory system tries to compensate by increasing your breathing rate. 

6. A general feeling of discomfort

People with cancer can develop lactic acidosis since cancer cells create lactic acid. As the disease progresses, cancer patients often lose weight, become ill, and generally feel unwell. You can also feel uncomfortable if you have lactic acidosis not related to cancer.

7. Weakness

Reduced oxygen delivery to your body from lactic acidosis can make you feel weak.

8. Fatigue

Similar to feeling weak, low oxygen levels can make you feel extremely tired.

9. Muscle pain

If you’ve ever felt a burning in your muscles after exercising, you felt lactic acid’s impact. Lactic acid is produced during activities such as endurance exercise and weight lifting. The sensation goes away once your liver clears the excess lactate from your body.

If you have high levels of lactate in your blood, you can feel all-over muscle pain without exercising.

10. High anion gap

One of the ways your healthcare provider diagnoses lactic acidosis is through blood tests. The anion gap blood test measures the difference in your body’s positive and negatively charged electrolytes. A high anion gap is indicative of lactic acidosis. 

How is lactic acidosis treated?

Lactic acidosis treatment varies depending on the cause. For instance, if an infection causes lactic acidosis, then you would likely be prescribed antibiotics.

The best way to treat lactic acidosis is to treat the root cause. Intravenous administration of sodium bicarbonate is a common treatment for lactic acidosis and helps reduce the acidity in your body.


Lactic acidosis is caused by low oxygen levels in your tissues and can also be caused by certain medications. Lactic acidosis leads to symptoms such as abdominal pain, nausea, vomiting, diarrhea, and extreme fatigue. 

The treatment of lactic acidosis depends on its root cause and typically requires medical attention if it’s caused by something more serious than over-exercising.

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  1. Misbin, Robert. The Phantom of Lactic Acidosis due to Metformin in Patients With Diabetes (2004) 
  2. Hur KY, Kim MK, Ko SH, et al. Metformin Treatment for Patients with Diabetes and Chronic Kidney Disease: A Korean Diabetes Association and Korean Society of Nephrology Consensus Statement. Diabetes Metab J. 2020;44(1):3-10.
  3. Feenstra RA, Kiewiet MK, Boerma EC, ter Avest E. Lactic acidosis in diabetic ketoacidosis. BMJ Case Rep. 2014;2014:bcr2014203594. Published 2014 Mar 20.

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