What are the other Names for this Condition? (Also known as/Synonyms)

• Lactate Acidosis

What is Lactic Acidosis? (Definition/Background Information)

• Lactic Acidosis occurs when there is a buildup of lactic acid in blood, resulting in a significant drop in blood pH value. This can lead to extreme fatigue, muscle cramps, abdominal pain, and body weaknesses
• Many conditions are known to predispose one to Lactic Acidosis, including severe bacterial infections, genetic disorders, and cancers. Lactic Acidosis can also be caused by excessive exercising, alcohol consumption, and medication prescribed for diabetes and HIV infection
• There are two types of lactic acid in the body, namely L-lactate and D-lactate. Depending on which type of lactic acid accumulates in the body, Lactic Acidosis can be classified as Type A Lactic Acidosis and Type B Lactic Acidosis
  • Type A Lactic Acidosis is caused by decreased perfusion to the tissue due to conditions such as dehydration, bacterial infections, and heart failure
  • Type B Lactic Acidosis occurs when there is abnormal cell function causing lactic acid accumulation. This can occur due to a variety of causes including decrease in perfusion to a localized area in the body
• Lactic Acidosis may be diagnosed through a blood test. Additional diagnostic tests may be necessary to elucidate the underlying disease/disorder causing the condition
• Bicarbonate medication is often administered in the form of intravenous fluid to treat Lactic Acidosis. Additional treatment may be administered for the underlying primary condition causing Lactic Acidosis. Antibiotics may be given to treat bacterial infections, if needed
• The prognosis of Lactic Acidosis is excellent in mild cases, with most individuals recovering fully from the condition. Severe cases may lead to septic shock or other complications, which can lead to unfavorable outcomes

Who gets Lactic Acidosis? (Age and Sex Distribution)

• Lactic Acidosis may develop in individuals of any age; both children and adults can be affected
• The condition is more likely to develop during the neonatal period in infants with metabolic genetic disorders
• Both male and female genders are equally likely to develop the condition
• Worldwide, individuals of all racial groups and ethnicity may develop Lactic Acidosis

What are the Risk Factors for Lactic Acidosis? (Predisposing Factors)

The risk factors associated with Lactic Acidosis include:

• Uncontrolled diabetes and/or complications of diabetes such as diabetic ketoacidosis
• Obesity
• Certain malignant conditions such as lymphoma and pheochromocytoma
• Conditions resulting in acute injury
• Severe dehydration that may be caused by overexertion from physical activities
• Severe liver disease
• Chronic alcoholism
• Acute heart failure
• Heart attack resulting in myocardial infarction
• Shock due to variety of underlying conditions
• Deficiency of vitamin B1 (thiamine)
• Presence of certain genetic disorders such as:
  • Biotin deficiency conditions
  • Fructose bisphosphatase deficiency
  • Glucose-6-phosphatase deficiency (G6PD)
  • Leigh syndrome
  • Maternally-inherited diabetes and deafness (MIDD)
  • Mitochondrial encephalopathy, Lactic Acidosis, and stroke-like episodes (MELAS)
  • Pyruvate dehydrogenase and pyruvate carboxylase deficiency disorders
• Medication related:
  • Antibiotics such as Linezolid and Isoniazid
  • Hormone medication such as epinephrine
  • Intake of antiretroviral drugs for HIV infection, such as Truvada (Tenofovir/Emtricitabine), and reverse transcriptase inhibitor (RTI)
  • Propofol, used for sedation
  • Propylene glycol
  • Tylenol or acetaminophen overdose
  • Use of certain medications such as metformin for diabetes. It is important to note there is a small risk for potentially severe Lactic Acidosis from metformin medication
• Polymyositis, leading to chronic muscle inflammation
• Sepsis, a severe medical condition
• Metabolic abnormality such as tumor lysis syndrome
• Cyanide poisoning

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Lactic Acidosis? (Etiology)

Lactic Acidosis can be caused be a multiple of medical problems, which range from a lack of oxygen supply to metabolic disorders.

• Decreased oxygen supply to the tissues: Lactic acid is produced as a byproduct of glycolysis, a body mechanism by which energy is produced. If for some reason prolonged glycolysis persists, then lactic acid can accumulate in the tissues and result in Lactic Acidosis. For example, after an extended period of strenuous exercise at high altitudes, where oxygen is scarce, one may develop Lactic Acidosis. It may also form due to certain other conditions such as heart failure, respiratory compromise, liver failure, septic shock, and carbon monoxide poisoning
• Lactic Acidosis can be caused by underlying metabolic problems such as glucose-6-phosphatase deficiency (G6PD). Genetic disorders that cause individuals to be deficient in certain enzymes along the metabolic pathway may cause a buildup of lactic acid in the body
• Excessive alcohol consumption: In case of alcohol intoxication, excessive alcohol may interfere with cellular respiration and prevent one’s cells from utilizing oxygen for generating energy. As a result, cells adopt the alternative method i.e., anaerobic respiration, to generate energy without using oxygen; thus, lactic acid is again produced as a by-product in blood
• Medications for diabetes and HIV infection, such as metformin, Truvada, and reverse transcriptase inhibitor, interfere with cellular respiration and causes anaerobic respiration to predominate and lactic acid to build up in blood. A prolonged intake period of these medications may sometimes lead to Lactic Acidosis
• Vitamin B1 deficiency disorder: Thiamine, or vitamin B1, is a cofactor in aerobic cellular respiration. Thiamine deficiency causes the cells within the body to switch to anaerobic respiration, thereby resulting in an accumulation of lactic acid

What are the Signs and Symptoms of Lactic Acidosis?

The signs and symptoms of Lactic Acidosis may include:

• Severe fatigue 
• Headache
• Nausea and vomiting
• Elevated heart rate
• Elevated respiratory rate 
• Loss of appetite
• Skin turning yellow (jaundice) 
• Muscle weakness and cramps
• Abdominal pain and discomfort

Additionally, the signs and symptoms of the underlying condition, if any present, may be noted.

How is Lactic Acidosis Diagnosed?

The following tests and examinations may be ordered in the diagnosis of Lactic Acidosis:

• Detailed physical examination and evaluation of one’s family and medical history
• Blood test will be needed to examine blood pH, oxygen saturation, lactate levels, glucose levels, and other electrolyte levels. Blood test is the primary method used in diagnosing Lactic Acidosis. Individuals with the condition may show reduced blood pH values, abnormally decreased saturation oxygen, and abnormal glucose levels. High plasma creatinine levels and lactate levels is also observed in this condition
• If signs and symptoms related to heart are present, electrocardiography (ECG) may be needed to examine for any heart abnormalities
• If signs and symptoms related to lung are suspected, a chest X-ray or a pulmonary function test may be taken to check for lung abnormality such as pulmonary edema
• If genetic disorder is suspected, molecular genetic testing may be carried out to look for mutations in genes implicated in such inherited metabolic diseases
• Other tests and exams may be necessary to detect or diagnose the underlying cause of Lactic Acidosis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Lactic Acidosis?

The complications of Lactic Acidosis may include: 

• Abnormal heart rhythms or arrhythmias
• Multiorgan failure
• Treatment with intravenous fluid may occasionally result in unintended complications such as acute kidney injury

Complication of the underlying condition may be also noted.

How is Lactic Acidosis Treated?

The following treatment measures may be employed to manage Lactic Acidosis:

• If Lactic Acidosis is drug-induced (such as caused by type II diabetes or HIV medication), the intake of these drugs may be stopped, or alternate drugs proposed by the healthcare provider
• If Lactic Acidosis is caused by thiamine or vitamin B1 deficiency, vitamin B1 supplement may be administered
• Sodium bicarbonate is usually administered either orally or intravenously, to restore blood pH values to normal ranges. Typically, intravenous administration will help in increasing blood serum pH faster
• The healthcare provider may undertake a red blood cell transfusion in severe cases, to increase one’s hemoglobin levels
• In the case of respiratory acidosis caused by airway obstruction, bronchodilators may be given to dilate one’s airway
• If Lactic Acidosis is caused by sepsis, intravenous fluid replacement will be needed. Additionally, antibiotics may be given to control the bacterial infection
• Dialysis may be performed to remove the substances in blood causing Lactic Acidosis, such as metformin. In addition, bicarbonate can also be delivered via dialysis to increase blood pH values to normal levels

How can Lactic Acidosis Be Prevented?

The following measures may be considered to prevent Lactic Acidosis:

• Avoiding chronic alcohol consumption; avoiding alcohol after taking sedatives
• Having a balanced diet
• Abstaining from smoking
• Keeping body weight within a healthy range 
• Avoiding excessive physical exercise, especially at higher altitudes
• Taking adequate fluids to stay hydrated
• Genetic carrier screening prior to pregnancy to screen for mutations in genes involved in metabolism is also recommended in high risk cases
• Availing early and adequate treatment of the underlying medical conditions causing Lactic Acidosis

What is the Prognosis of Lactic Acidosis? (Outcomes/Resolutions)

The prognosis of Lactic Acidosis varies from one individual to another. It is dependent on the severity of the condition and the underlying factors that is responsible for Lactic Acidosis.

• In mild cases, individuals may recover fully within a matter of few hours to few days. For instance, one may recover from Lactic Acidosis rapidly within a few hours or a day after physical overexertion
• Lactic Acidosis is often reversible in cases that are not caused by underlying genetic disorders or organ failure
• In severe cases, individuals may rarely have multiple organ impairment and failure. In such cases, the prognosis is usually poor, especially if damage to organs are extensive and irreversible
• Also, individuals with heart attacks or septic shock from high lactic acid levels have poor prognosis despite treatment

Additional and Relevant Useful Information for Lactic Acidosis:

If one is prescribed with type II diabetes medication or HIV medication, one should watch out for symptoms of Lactic Acidosis and consult their healthcare provider immediately, if a drug-induced Lactic Acidosis is suspected.