Lactic acidosis is a clinical condition where there is an active accumulation of lactic acid in the serum. The rate of buildup of lactic acid in lactic acidosis is faster than the body’s capacity to eliminate it. Lactic acid accumulates in the system when oxygen level in the body drops.
The following signs and symptoms are commonly seen in patients having lactic acidosis:
The following diagnostic modalities and tests are implored in patients suspected of having lactic acidosis:
Patients diagnosed with lactic acidosis may benefit from the intravenous administration of sodium bicarbonate. This therapeutic intervention is proven to decrease the carbon dioxide concentration in the pulmonary artery and increase the pH of the serum. Some patients may be given dichloroacetate to stimulate the production of lactate dehydrogenase to eliminate the accumulation of lactate and pyruvate.
Carbicarb has used as a potent buffering agent for the treatment of acidemic events in the body. In the face of a worsening lactic acidosis with impending renal failure or cardiovascular failure, hemodialysis seem to be the only option to prevent fluid overload and the needless accumulation of carbon dioxide in the serum . Patients may be given thiamine (vitamin B1) supplements to help oxidize serum acids.
Patients presenting with serum levels of lactate above 2.5 mmol/L are associated with an increased risk for morbidity and mortality . Hyperlactatemia associated with anti-retroviral therapy hardly causes any mortality. However, critically ill patients with pH below 7.35 and serum level of lactate beyond 5 mmol/L have a very poor prognosis. Patients having hyperlactatemia with concurrent metabolic acidosis have more than double the risk of dying than those without indications for metabolic acidosis .
The following medical conditions can result in the accumulation of lactate in the serum:
The exact prevalence and incidence rate of lactic acidosis is hard to document for they usually occur in the critically ill patients who are sensitively unavailable for research interviews and examinations. Prevalence of lactic acidosis abounds in the high dependency areas of the hospitals . There is an increasing trend in symptomatic lactic acidemia among patients under anti-retroviral therapy for AIDS . Patient incidence rating reaches up to 35 cases per 1000 population under anti-retroviral regimens.
In general lactic acidosis appear in conjunction with several disease conditions that afflict mankind. The state of hyperlactatemia has been associated with the progression and deterioration of the underlying primary disease. In some medical condition like cardiopulmonary failure, lactic acidosis worsens as an effect of drugs and toxins used to allay the primary disease conditions. With severe and vigorous exercise, lactate accumulation is an imperative byproduct of the anaerobic respiration of the muscle cells. The body’s inability to keep up in naturally eliminating the lactic acid in the tissue causes the adverse symptoms of lactic acidosis. The progressive failure of the body’s acid buffering system to counteract the lactate accumulation has been elucidated as the primary culprit in lactic acidosis observed in intense exercise and intake of certain drugs.
The occurrence of lactic acidosis is easily preventable when there is a prompt diagnosis and therapeutic intervention done on the primary underlying illness. Athletes should do pre-activity stretching to avoid muscular injuries that might aggravate the accumulation of lactate in the muscles. A post-activity sports massage on the affected extremities will assist the rapid disposal of the lactic acid accumulation.
Alcohol use should be taken in moderation to avoid lactate accumulation in the serum. Diabetics and patients with impending cardiovascular disorders must submit to frequent physician’s follow-up and comply regularly with maintenance medications to avoid complications like lactic acidosis and metabolic acidosis. Patients with impending infection should be treated adequately with the appropriate antibiotic therapy to avoid the occurrence of septicemia. An annual tumor body scan to promptly diagnose ongoing and occult malignancies.
Lactic acidosis is a type of metabolic acidosis due to the inadequate disposal of lactic acid by the body leading to its accumulation in the serum. Lactate is a common byproduct of anaerobic respiration which is essentially cleared in the liver, kidneys, and the muscles. Lactic acidosis occurs when the natural buffering system of the body fails and serum pH falls below 7.25. Accumulation of lactate in the serum is also eminent at >2 mmol/L technically referred to as hyperlactataemia.