What is lactic acidosis?

• Severe acidosis with hyperventilation. • Blood pH below 7.30. • Serum bicarbonate 15 mEq/L. • Absent serum ketones. • Serum lactate > 5 mmol/L.

What are the symptoms of lactic acidosis?

A. SYMPTOMS AND SIGNS The main clinical feature of lactic acidosis is marked hyperventilation. When lactic acidosis is secondary to tissue hypoxia or vascular collapse, the clinical presentation is variable, being that of the prevailing catastrophic illness. However, in the idiopathic, or spontaneous, variety, the onset is rapid (usually over a few hours), blood pressure is normal, peripheral circulation is good, and there is no cyanosis. B. LABORATORY FINDINGS Plasma bicarbonate and blood pH are quite low, indicating the presence of severe metabolic acidosis. Ketones are usually absent from plasma and urine or at least not prominent.

How is lactic acidosis treated?

Aggressive treatment of the precipitating cause of lactic acidosis is the main component of therapy, such as ensuring adequate oxygenation and vascular perfusion of tissues. Empiric antibiotic coverage for sepsis should be given after culture samples are obtained in any patient in whom the cause of the lactic acidosis is not apparent. Alkalinization with intravenous sodium bicarbonate to keep the pH above 7.2 has been recommended by some in the emergency treatment of lactic acidosis; as much as 2000 mEq in 24 hours has been used. However, there is no evidence that the mortality rate is favorably affected by administering bicarbonate, and its use remains controversial.

What is the outlook for lactic acidosis?

The mortality rate of spontaneous lactic acidosis is high. The prognosis in most cases is that of the primary disorder that produced the lactic acidosis.

Diabetes & Hormones · In-depth guide

Lactic Acidosis

Medically reviewed byGerald Hurowitz, M.D.Updated 19 June 20103 min read

Key points

Lactic acidosis is characterized by accumulation of excess lactic acid in the blood.
SYMPTOMS AND SIGNS The main clinical feature of lactic acidosis is marked hyperventilation.
Aggressive treatment of the precipitating cause of lactic acidosis is the main component of therapy, such as ensuring adequate oxygenation and vascular perfusion of tissues.
The mortality rate of spontaneous lactic acidosis is high.

Explore Lactic Acidosis

Introduction

Severe acidosis with hyperventilation.
Blood pH below 7.30.
Serum bicarbonate < 15 mEq/L.
Anion gap > 15 mEq/L.
Absent serum ketones.
Serum lactate > 5 mmol/L.

General Considerations

The Hypoglycemic States

Introduction

Hypoglycemia due to Pancreatic B cell tumors

Persistent Islet Hyperplasia(NonInsulinoma Pancreatogenous Hypoglycemia Syndrome)

Hypoglycemia Due to Extrapancreatic Tumors

Postprandial Hypoglycemia (Reactive Hypoglycemia)

Alcohol-Related Hypoglycemia

Factitious Hypoglycemia

Immunopathologic Hypoglycemia

Drug-Induced Hypoglycemia

Lactic acidosis is characterized by accumulation of excess lactic acid in the blood. Normally, the principal sources of this acid are the erythrocytes (which lack enzymes for aerobic oxidation), skeletal muscle, skin, and brain. Conversion of lactic acid to glucose and its oxidation principally by the liver but also by the kidneys represent the chief pathways for its removal. Overproduction of lactic acid (tissue hypoxia), deficient removal (hepatic failure), or both (circulatory collapse) can cause accumulation.

Lactic acidosis is not uncommon in any severely ill patient suffering from cardiac decompensation, respiratory or hepatic failure, septicemia, or infarction of bowel or extremities. With the discontinuance of phenformin therapy in the United States, lactic acidosis in patients with diabetes mellitus has become uncommon but occasionally occurs in metformin-treated patients and it still must be considered in the acidotic diabetic, especially if the patient is seriously ill.

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Diabetes & Hormones · In-depth guide

Lactic Acidosis

Medically reviewed byGerald Hurowitz, M.D.Updated 19 June 20103 min read

Key points

Lactic acidosis is characterized by accumulation of excess lactic acid in the blood.
SYMPTOMS AND SIGNS The main clinical feature of lactic acidosis is marked hyperventilation.
Aggressive treatment of the precipitating cause of lactic acidosis is the main component of therapy, such as ensuring adequate oxygenation and vascular perfusion of tissues.
The mortality rate of spontaneous lactic acidosis is high.