Lactic Acidosis
Lactic Acidosis: Definition, Causes, Symptoms, Diagnosis, and Treatment
Definition
Lactic acidosis is a medical condition characterized by an excessive buildup of lactic acid in the bloodstream, leading to a decrease in blood pH (acidemia). It occurs when lactate production exceeds clearance, often due to insufficient oxygen delivery to tissues or impaired metabolism of lactate.
Types
- Type A Lactic Acidosis: Caused by tissue hypoxia or hypoperfusion (lack of oxygen), such as in shock, severe anemia, respiratory failure, or cardiac arrest.
- Type B Lactic Acidosis: Occurs without hypoxia and is subdivided into:
- B1: Due to underlying diseases (e.g., liver failure, kidney failure, cancer).
- B2: Due to drugs or toxins (e.g., metformin overdose, linezolid, cyanide poisoning).
- B3: Due to rare inherited metabolic disorders affecting lactate metabolism.
Causes
- Severe illnesses causing low blood pressure and poor oxygen delivery (sepsis, shock, heart failure).
- Intense exercise or convulsions (transient).
- Diseases: AIDS, cancer, cirrhosis, kidney failure, respiratory failure.
- Medications: Metformin (especially overdose), beta-agonists (albuterol), linezolid, nucleoside reverse transcriptase inhibitors, propofol.
- Poisonings: Cyanide.
Symptoms
- Early symptoms: Nausea, vomiting, weakness, fatigue, muscle cramps, body aches.
- Advanced symptoms: Rapid, shallow breathing (Kussmaul respirations), confusion, disorientation, jaundice, rapid heart rate, fruity-smelling breath.
- Severe cases: Shock, organ failure, coma.
Diagnosis
- Blood tests showing elevated lactate levels (>4 mmol/L).
- Arterial blood gas revealing low pH (acidosis) and low bicarbonate.
- Electrolyte imbalances may be present.
- Additional tests to identify underlying causes.
Treatment
- Address underlying cause (e.g., infection, hypoxia, drug toxicity).
- Supportive care: Oxygen therapy, intravenous fluids, correction of electrolyte imbalances.
- Discontinue or adjust offending medications.
- In severe cases, renal replacement therapy (dialysis) may be needed to remove excess lactate.
- Monitoring in intensive care settings for critical cases.
Prognosis
- Depends largely on the underlying cause and promptness of treatment.
- Can be life-threatening if untreated.
- Early recognition and management improve outcomes.
Summary Table
| Aspect | Details |
|---|---|
| Definition | Excess lactic acid buildup causing blood acidemia |
| Types | Type A (due to hypoxia), Type B (due to disease, drugs, or metabolic defects) |
| Common Causes | Sepsis, shock, respiratory failure, metformin overdose, liver/kidney failure |
| Symptoms | Nausea, vomiting, fatigue, rapid breathing, confusion, jaundice |
| Diagnosis | Elevated blood lactate (>4 mmol/L), low blood pH, blood gas analysis |
| Treatment | Treat underlying cause, supportive care, discontinue offending drugs, dialysis if needed |
| Prognosis | Variable; depends on cause and treatment timing |
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References:
Lactic acidosis is a serious condition signaling impaired oxygen delivery or metabolism. Prompt diagnosis and treatment of the underlying cause are essential to prevent severe complications and improve survival.
