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Lactic acidosis is a metabolic disorder that results from an excess build-up of lactate in the body. Lactic acidosis can occur, inter alia, in in people with diabetes, although this is very rare. However, if it develops in a diabetic, it poses a very great threat to his life, as the mortality rate then reaches even 50%. What are the causes and symptoms of lactic acidosis? What is the treatment?

Lactic acidosisis a state of increased blood acidity (when the blood pH drops below the value of 7.30), which is a result of the accumulation of lactic acid in the blood above normal, i.e. above 5 mmol / l. Lactic acid is a compound formed in the muscles during their work, specifically in the process of the so-called anaerobic glycolysis, i.e. glucose combustion, which is the main source of energy for working muscles in conditions of oxygen deficiency.

Lactic acidosis - causes

Lactic acidosis is most often the result of severe tissue hypoxia (type A of lactic acidosis), which may occur in the course of

  • septic, cardiogenic shock
  • acute heart attack
  • stroke
  • sepsy
  • acute and chronic respiratory failure (e.g. severe pneumonia, pulmonary embolism, pneumothorax)

Type A lactic acidosis can also develop in people who have lost a large amount of blood, for example, from an injury or exacerbation of disease (such as a ruptured aortic or other large vessel aneurysm), and in severe anemia.

Type B lactic acidosis occurs due to causes other than hypoxia. It can occur as a result of poisoning with ethyl alcohol, methyl alcohol, glycol, large doses of salicylates, cyanides, carbon monoxide. It also occurs in patients struggling with liver failure or proliferative diseases.

People with diabetes are also susceptible to this type of lactic acidosis. Lactic acidosis rarely occurs in diabetics. However, if it does develop, it is characterized by a much higher mortality (up to 50%) than in ketoacidosis, which is a common complication of diabetes. Diabetic lactic acidosis is usually a side effect of metformin or biguanides (anti-diabetic medications) whencontraindications (e.g. renal failure, atherosclerosis).

Lactic acidosis - symptoms

  • digestive symptoms - nausea, vomiting, abdominal pain, diarrhea;
  • respiratory symptoms - shortness of breath, rapid and deep breathing - the so-called acidic breath (Kussmaul breath);
  • hypothermia (lowering body temperature);
  • pressure reduction;
  • oliguria;
  • symptoms of dehydration (e.g. feeling of extreme thirst, deep rapid breathing, decreased blood pressure, dry mouth, headaches);
  • disturbance of consciousness, delirium, drowsiness;

If proper treatment is not undertaken, the so-called lactate coma.

Lactic acidosis - diagnosis

Blood tests are performed if lactic acidosis is suspected. There is a decrease in blood pH (5 mmol / L), an anion gap (difference between sodium concentration and the sum of chlorine and bicarbonate concentrations:>16 mmol / L), decreased bicarbonate concentration (<10 mmol / L) and an increase in potassium. However, the concentration of sodium and glucose in the blood does not change ( although in some cases glycemia may be moderately elevated).

If it is suspected that metformin may be the cause of the acidosis, serum creatinine should also be measured.

Lactic acidosis - treatment

According to the recommendations of the Polish Diabetes Association, treatment of lactic acidosis includes:

  • counteracting shock by compensating for dehydration and hypovolemia (reduction of circulating blood volume), moderate administration of peripheral vasoconstrictors;
  • counteracting hypoxemia (oxygen deficiency in the blood) and hypoxia (oxygen deficiency in tissues) by supplying oxygen and possibly supporting respiration;
  • counteracting the excessive formation of lactic acid through the infusion of glucose and insulin under glycemic control;
  • alkalization, i.e. neutralization of the acidic pH of the blood, with sodium bicarbonate (administered intravenously);
  • in justified cases, renal replacement therapy is necessary - hemodialysis (to remove lactic acid, and thus balance the acid-base balance and electrolyte disturbances);

In addition, in the case of hypotension (hypotension), the patient is administered catecholamines (adrenaline, noradrenaline, dobutamine). If a doctor diagnoses an embolism, he may consider thrombolytic therapy in addition to anticoagulants. In the case of high blood loss or anemia, blood substitutes or blood transfusions are used.

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Gastrology