Lactic acidosis

definition

Lactic acidosis leads to an increased concentration of lactic acid in the blood, which causes the pH value to fall below the physiological range and consequently shift to acidic values.

A change in pH from acidosis can have serious effects. Normally human blood is slightly basic or alkaline due to the dissolved salt. With acidosis, the blood becomes slightly acidic.

Read more on the topic: PH value

Causes of latic acidosis

Lactic acidosis usually results from a disturbed cell metabolism, in which the oxygen-consuming (aerobic) Glucose utilization not functional can expire. As an intermediate product of incomplete glucose metabolism, it often accumulates as a result Lactate because the energy production from glucose to lactate is possible without oxygen. This leads to an increased utilization of the anaerobic-lactacid energy supply (anaerobic = without oxygen).

In the Lactic acidosis arises under Lack of oxygen the Pyruvate from the Glycolysis and is converted to lactic acid. Glycolysis is the process in which carbohydrates are broken down into simple sugars and added to the bloodstream. The liver can Lactate reduce to a certain extent and compensate for lactic acidosis to some extent. If the liver function declines, however, the accumulation of lactate can no longer be stopped and the body becomes acidic.

Lactic acidosis is common Diabetics as part of a diabetic ketoacidosis on. Can also be causative liver- and Kidney disease, as well as a Blood poisoning (sepsis) be. Normally, excess lactate gets in the liver under the Glucose build-up (Gluconeogenesis) recycled and thus degraded. However, if there is liver disease, this process can be restricted and lactate accumulates. Especially with massive lactate accumulation, the damaged liver can no longer compensate for the condition.

Ask another cause life threatening conditions as a shock, one Pulmonary embolism and major operations in which tissue is sometimes insufficiently supplied with blood and consequently is no longer adequately supplied with oxygen, which is why the body has to fall back on the energy generated by the formation of lactate. Under a high Blood sugar level at Diabetics For example, the body is dehydrated so that too little blood remains in the vascular system. There is a so-called hypovolemic shock. As a result of this shock, organs are insufficiently supplied with blood and consequently insufficiently supplied with oxygen, and lactic acidosis develops.

Also various medications, like above all that Antidiabetic drug Metformin, can lead to lactic acidosis. Drugs that cause lactic acidosis, usually inhibit the respiratory chainwhich creates less oxygen and is available for energy production, which is why you have to switch to the lactate metabolism. Also a lack of Thiamine (Vitamin B1), as part of the Beriberi Syndromewhich often by Malnutrition and alcoholism provoked can lead to lactic acidosis. The thiamine deficiency causes the Citric acid cycle throttled, thereby increasing the intermediate Pyruvate which can be converted to lactate. Also in the context of Tumor diseases Lactic acidosis can occur as some tumors produce lactate.

Lactic acidosis in extreme athletes

In rare cases it can also occur with Extreme athletes lead to lactic acidosis, since with heavy physical exertion the metabolism drops to a certain threshold anaerobic energy production (without oxygen) falls back. This is a physiological and usually harmless process, but if done to an extreme extent it can lead to lactic acidosis. In this case, therapy is usually sufficient for the athlete to take some time off and take breaks between physical activity so that the metabolism can return to normal.

Signs

The symptoms lactic acidosis can vary greatly. Belong to them nausea, Vomit, stomach pain, faster breathing, Racing heart and a Change in mental state can also adjust. Furthermore are Anxiety, fatigue, irregular heart rate, lethargy and weakness symptoms to be expected with lactic acidosis.

A typical sign of lactic acidosis is the so-called Kussmaul breathing. She serves the compensation acidification of the body. It is a deep and regular breathing in which the body tries to breathe out the excess acid in the form of carbon dioxide. Often there are also Restlessness, Shortness of breath, fever and Circulatory disorders. The patients often become noticeable in the further course increasing confusion and Clouding of consciousness up to a coma.

The course of lactic acidosis

The history lactic acidosis differently be. It is a very rare disease and a lot depends on the underlying cause. At Professional and extreme athletes the disease mostly sounds again completely if appropriate breaks are used. At a Organ disorder as the cause, especially with kidney and liver, the likelihood of fatal lactic acidosis is highest.

Consequences / complications

In severe cases, lactic acidosis can lead to shock, including life-threatening kidney failure. Is the lactic acidosis due to a Organ damage before how one Kidney or Liver damage, it can also be fatal. In this case it should medical help should be contacted immediately. Signs of critical stage lactic acidosis are: blue colored lips or fingernails, changes in nature and state of consciousness (Faint, Listlessness), chest pain, chest pressure, palpitations, high fever (higher than 38.5 ° Celsius), breathing problems (shortness of breath, rapid breathing, respiratory arrest) and severe stomach pain. In the event of these symptoms, an emergency call should be made immediately, as otherwise serious health problems and even death can result.

Metformin

In recent years, deaths from antibiotic use of metformin have increased in Europe. Experts counted 37 deaths in the last ten years, 29 of which were due to lactic acidosis.The exact mechanism of action is not clear and therefore you should always clarify whether you can take the drug and what to look out for. Similar drugs were withdrawn from the market in the 1970s and 1980s due to frequent post-ingestion deaths. Metformin is the last anti-diabetic drug left on the market.

Metformin is an anti-diabetic drug that belongs to the biguanides. It blocks the transport of electrons in the respiratory chain, which means that less oxygen is produced and the anaerobic metabolism, i.e. the lactate-producing metabolism, is driven.

Patients with impaired liver function are particularly at risk of developing lactic acidosis during therapy with metformin. In addition to the respiratory chain, metformin presumably also inhibits gluconeogenesis (Formation of glucose) in the liver. Lactate is used as a building block for this metabolic pathway. As a result of the inhibition of gluconeogenesis, more lactate accumulates, which a damaged liver is more difficult to eliminate than a healthy liver.

Lactic acidosis can also occur with impaired kidney function, as metformin is eliminated via the kidneys. If kidney function is impaired, the drug is excreted more slowly and plasma levels rise. This results in a longer effectiveness of the drug, which means that lactate levels can continue to rise. Because of this relationship, kidney values ​​are checked in all patients before they are prescribed metformin. A contraindication is present if the creatinine value is at least 1.5 mg / dl in men and 1.4 mg / dl in women and if the creatinine clearance is below 60 ml / min.

Lactic acidosis caused by metformin has been linked to increased mortality. 30% of the patients die from it.

Diagnosis

Lactic acidosis can only be confirmed through a laboratory test due to the unspecific symptoms. From one Lactic acidosis one speaks when the pH below 7.36 lies and at the same time the Lactate concentration above 5 mmol / l is increased. If only the pH value is lowered and the lactate concentration is largely in the physiological range, it is a question of metabolic acidosis.

Therapy of lactic acidosis

Usually find Treatments for lactic acidosis in the intensive care unit of a hospital. There the patient can be monitored around the clock, and the circulation will be stabilized. To the high Lower acid concentration in the body, often becomes the antidote "Bicarbonate" administered.

But you can too measure seize that one Prevent lactic acidosis. When administering medication you should always clarify, if kidney and Liver function properly and, whether the drug has the potential to cause lactic acidosis. With the smallest organic restrictions from kidney and liver can cause lactic acidosis when taking medication side effect occur.

The body has one built-in protection function which takes effect when the lactate concentration reaches a certain level Level exceeds. In such a case, the body begins to increase breathingto lower the level of lactate in the blood by exhaling carbon dioxide.

For the therapy of lactic acidosis to be effective, the provoking cause must be eliminated. At the beginning of the therapy, the Cycle usually stabilized by intensive medical measures. The gift of basic / alkaline bicarbonatewhich the Acidosis / acidosis can neutralize. It has to the production of lactic acid slows down or stopped so that the body can break down the accumulated lactate. However, bicarbonate should be used carefully, as it can also worsen the existing acidosis. If the acidosis is caused by the administration of Metformin treatment is stopped immediately; these are other options for treating lactic acidosis Syringes of certain liquidsthat help improve the oxygen supply and so to counteract lactate production, and one Oxygen therapyso that the body receives enough oxygen again. As part of a diabetic derailment, for example insulin injected to the Lower blood sugar levels again. Besides, you can still Vitamin therapies perform or dialysis treatments to prevent that blood can be purified from the acid. Lactic acidosis is caused by an irreversibly damaged one liver, it can only be through one Liver transplant be treated.

If lactic acidosis is not treated, serious health problems can arise and may persist. In order to avoid and prevent life-threatening situations, one should be aware of the signs mentioned see a doctor and get treatment for lactic acidosis. If there is no therapy, it can Cardiac arrhythmias, a sporting decline in performance, Shocks, Infectious diseases or unconsciousnessto the point of coma.

dialysis

If you have severe lactic acidosis, you will need dialysis (Blood washing) are used to remove excess lactate from the blood. Dialysis is usually used in end-stage renal insufficiency, mainly to filter toxic waste products and excess electrolytes from the blood. In the context of lactic acidosis, dialysis is mainly used when the blood pH value is below seven and / or the lactate concentration in the blood is above 90 mmol / l. Typically, the lactate reference value is 0.5 to 2.2mmol / l and the blood pH is between 7.37 and 7.45.