Lactic acidosis occurs when lactic acid builds up in the bloodstream.
This can lead to health complications, such as liver problems, and sometimes kidney issues.
Here, we will take a quick look at lactic acidosis and its impact on the human body.
We will discuss its symptoms, how doctors diagnose it, what treatment options are available, and what you can do to prevent it from occurring.
What Is Lactic Acidosis?
Lactic acid is typically created in excess by roughly 20 mmol/kg per day. Lactic acid enters the bloodstream, after which it is metabolized via the kidney and liver.
Certain tissues can use lactate and oxidize it to water and CO2 (carbon dioxide). However, only the kidney and liver have what it takes to make use of lactate for gluconeogenesis.
Lactic acidosis is a medical condition recognized by lactate build-up or elevated lactate. It is a type of metabolic acidosis in which a high amount of acid accumulates because the body develops an issue with oxidative metabolism.
Two types of lactic acid exist. D lactate and L lactate. Most lactic acidosis cases are the result of excess L lactate production. With that in mind, two types of lactic acidosis can develop.
Type A lactic acidosis
This acidosis is the result of hypoxia and hypoperfusion. Hypoxia means having low oxygen levels in the tissues. The word hypoxia is often used to describe a lack of oxygen in the blood (hypoxemia).
The examples for this type of acidosis include: regional ischemia, all shock states (septic shock, obstructive, cardiogenic, hypovolemic shock), convulsions, seizures, and severe shivering.
Type B lactic acidosis
This acidosis is less common compared to type A acidosis. It is defined as not having to do with tissue hypoperfusion or tissue hypoxia.
D lactic acidosis
Another rather unusual form of lactic acidosis is D lactic acidosis. It happens in individuals with short bowel syndrome. D lactic acid has also been found in patients who take huge amounts of propylene glycol and people with diabetic ketoacidosis.
As a marker of tissue perfusion, lactate clearance is impacted not just by the macrocirculation, but by microcirculation (network of capillaries, arterioles, and venules) as well. Including the mitochondrial function.
Pyruvate production from glycolysis gets pulled into two primary metabolic pathways. In the lactic acid cycle, pyruvate gets converted to lactate. The excess lactate due to pyruvate production gets shuttled to the liver.
Glycolysis creates 2 ATP per glucose molecule. So, it offers a direct way to produce energy when there isn’t enough oxygen. The process of breaking down the glucose due to lack of oxygen is called anaerobic glycolysis.
It can be difficult to spot the spike in lactate concentration. You can easily confuse the rising lactate levels from metabolic acidosis with another ailment.
The symptoms of lactic acidosis may include:
- Muscle loss
- Difficulty breathing or taking rapid breaths
- Breath that smells fruity
- Cramping and pain
- Drop-in appetite
- Body weakness
- Physical discomfort
- Severe fatigue
Severe lactic acidosis can lead to notable body weakness and exhaustion. Due to the increased lactic acid production, some patients also experience diarrhea and abdominal pain. So, it is critical to mitigate your lactate levels.
Otherwise, untreated lactic acidosis can prompt complications such as unconsciousness, irregular heart rhythm, or coma. Talk to a doctor to have your lactic acid levels managed.
There are countless triggers for elevated lactate. Metabolic acidosis occurs when a patient underutilizes or overproduces lactic acid. Unfortunately, their system can’t keep up with these drastic lactate level changes.
Some of the causes for elevated lactate concentration include:
- Shock (i.e., obstructive, cardiogenic, distributive shock)
- Post-cardiac arrest
- Regional tissue ischemia (such as burns, trauma, compartment syndrome, etc.)
- Drugs or toxins (i.e. alcohol, cocaine, carbon monoxide)
- Inadequate stores of thiamine
- Ailment (like heart disease, HIV, or cancer)
- Severe infection (sepsis) – any type of bacterial or viral infection can lead to sepsis. Sepsis may cause a spike in blood lactate levels.
- Liver failure
- Pharmacological agents (metformin, propofol, epinephrin)
Lactic Acidosis and Diabetes
Lactic acidosis has an increased anion gap. It is recognized by >5 mmol/L serum lactate levels. An anion gap test of the serum lactate level will tell you how much acid is present in the blood. The anion gap measurement of the lactic acid level can indicate if the body is dealing with electrolyte imbalance.
Acidosis due to elevated lactate levels isn’t a disease-specific complication from diabetes. It’s caused by other factors that are often seen in people with shock. Metformin-induced acidosis is more specific to diabetes. But, it is rare.
Reports indicate that the prevalence of a problem such as this is 4.3 cases per 100,000 people treated with metformin. Acidosis happens less frequently compared to other complications in diabetic patients that could lead to coma. But, when acidosis does happen, the mortality rate could skyrocket to 50%.
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A doctor will suggest you do a fasting blood test. They may also advise you to refrain from drinking or eating 8-10 hours prior to taking the test. Except for water. Curbing the activity level may also come in handy.
The test will evaluate your blood lactate and whether you need treatment.
To treat the circulating lactate, you first need to get to the root of the problem. That’s why the treatment methods vary.
Overall, the treatment for elevated lactate is aimed at improving perfusion to the affected tissue. Sometimes your doctor may recommend surgery. A surgical procedure aims to take out the damaged tissue and restore circulation to later manage blood lactate concentration.
Sometimes the acidosis causes a medical emergency. Doctors will use IV fluids and boost the oxygen level.
But, if the acidosis is the result of too much physical activity, then you can treat it at home. Take a break and drink plenty of water. Sleep helps as well.
In patients with severe acidosis, the use of bicarbonate therapy remains controversial. Most, but not all experts believe bicarbonate can be a viable option in acutely ill patients. But, there isn’t enough research on whether bicarbonate can help all patients with profound acidosis.
If you have trouble with the lactate metabolism, then talk to a doctor. They can take an adequate lactate measurement and suggest the best options for treatment.
You can’t really prevent lactic acidosis or lactate troubles for good. But, there are a couple of things you can do to mitigate the risk. To curb the risk of metabolic acidosis, stay hydrated and manage your diabetes. Avoiding heavy drinking can also help.
While to decrease the possibility of respiratory acidosis, it is imperative that you stop smoking. Smoking damages the lungs and may lead to poor renal function. Renal insufficiency is the result of insufficient blood flow to the kidneys.
Maintaining a healthy weight helps the lungs function. If you’ve been prescribed sedatives, taking them can help. But, make sure not to mix them with ethanol.
Lactic acidosis is a complex issue. Your treatment will depend on what’s causing the problem.
The sooner you start with lactic acidosis treatment, the better. In many patients, it can lead to a full recovery.
But, you can also implement some preventive tactics to mitigate the risk of developing lactic acidosis.