Lactic Acidosis

Lactic acidosis is a severe medical condition characterized by the buildup of lactic acid in the body, leading to a decrease in blood pH. This condition can be life-threatening and requires immediate medical attention.

What is Lactic Acidosis?

Lactic acidosis occurs when lactic acid accumulates in the bloodstream faster than it can be removed. This buildup lowers the pH, making the blood more acidic. Based on its underlying causes, the condition can be classified into different types.

Types of Lactic Acidosis

Type A Lactic Acidosis: This form is associated with tissue hypoxia, where there is inadequate oxygen supply to tissues. Common causes include severe infections, cardiac arrest, and severe anaemia.
Type B Lactic Acidosis: This type is not related to hypoxia and can be caused by various factors such as liver failure, certain medications (like metformin), and congenital metabolic disorders.

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Causes of Lactic Acidosis

Metformin-Associated Lactic Acidosis

One of the most well-known causes of lactic acidosis is the use of metformin, a common medication for type 2 diabetes. Though rare, metformin-associated lactic acidosis (MALA) can occur, particularly in patients with renal impairment or those undergoing surgical procedures. The risk is heightened when metformin accumulates due to decreased kidney function, leading to an increase in lactic acid production.

Other Causes

Severe Infections: Conditions such as septicemia can lead to tissue hypoxia, resulting in lactic acidosis.
Cardiovascular Issues: Heart failure and cardiac arrest can impede oxygen delivery to tissues, causing type A lactic acidosis.
Liver Disease: The liver plays a crucial role in metabolizing lactic acid. Liver failure or severe liver dysfunction can lead to lactic acid buildup.
Congenital Metabolic Disorders: Genetic conditions affecting enzymes involved in lactic acid metabolism can cause congenital lactic acidosis.

Symptoms of Lactic Acidosis

General Symptoms

The symptoms of lactic acidosis can vary but generally include:

Rapid breathing (tachypnea)
Nausea and vomiting
Abdominal pain
Muscle weakness
Lethargy
Confusion or altered mental state

Metformin-Associated Symptoms

In the context of metformin use, additional symptoms may include:

Malaise
Myalgias (muscle pain)
Hypotension (low blood pressure)

Diagnosis of Lactic Acidosis

Diagnosis of lactic acidosis involves several steps:

Clinical Evaluation: A thorough patient history and physical examination are crucial. Physicians will look for symptoms such as tachypnea, altered mental state, and underlying conditions that might contribute to lactic acidosis.
Laboratory Tests: Blood tests are essential for measuring lactate levels. A lactate level above five mmol/L is indicative of lactic acidosis. Arterial blood gas analysis can reveal metabolic acidosis with a low blood pH.
Imaging and Additional Tests: Depending on the suspected cause, imaging studies like CT scans or MRIs and additional tests like liver function tests or renal function assessments may be required.

Treatment of Lactic Acidosis

Immediate Interventions

The primary goal in treating lactic acidosis is to address the underlying cause and restore normal pH levels. Immediate interventions may include:

Oxygen Therapy: To ensure adequate oxygen delivery to tissues.
Intravenous Fluids: To correct dehydration and improve renal function.
Bicarbonate Therapy: In severe cases, sodium bicarbonate may be administered to neutralise acid in the blood.

Addressing the Underlying Cause

Discontinuation of Metformin: For patients with MALA, stopping metformin is crucial. Renal function should be closely monitored, and alternative diabetes management strategies should be considered.
Infection Control: For septic patients, aggressive antibiotic therapy and supportive care in an intensive care unit (ICU) are often required.
Cardiovascular Support: Patients with heart failure or cardiac arrest may need advanced cardiac life support measures.
Liver Support: In cases of liver failure, treatments may include liver transplantation or other supportive measures.

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Prevention of Lactic Acidosis

Monitoring and Management

Regular Monitoring: For patients on metformin, regular monitoring of renal function is essential. Kidney function tests should be performed periodically to ensure metformin is being cleared effectively.
Dose Adjustments: In patients with declining renal function, metformin dosage should be adjusted or discontinued as necessary.
Awareness of Symptoms: Educating patients about the symptoms of lactic acidosis can lead to early detection and treatment.

Lifestyle Modifications

Healthy Diet and Exercise: Maintaining a healthy lifestyle can improve overall metabolic health and reduce the risk of conditions that might lead to lactic acidosis.
Hydration: Adequate hydration helps maintain renal function and prevent the buildup of lactic acid.

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