What is Lactic Acidosis, Know its Types, Symptoms, Causes, Treatments, Prevention and Prognosis

Lactic acidosis is a medical condition and a type of acidosis that occurs when the blood of the affected person turns extremely acidic because of the presence of too much lactic acid in the body. In the following array of the article, we will know more about Lactic acidosis, the types, symptoms, causes, and treatments for the condition.

Lactic acidosis is a condition that is characterized by lactate buildup in the body, with the formation of an extremely low pH in the bloodstream. This medical condition is a form of metabolic acidosis, where there is an accumulation of excessive acid because of a problem with the oxidative metabolism of the body.

This medical condition occurs because of an underlying acute or chronic medical condition, poisoning, or medication. The symptoms of lactic acidosis are usually attributable to these underlying causes, however, might include vomiting, nausea, labored and deep breathing, and generalized weakness.

Lactic acidosis can be diagnosed based on biochemical analysis of blood. In some cases, hemofiltration is required temporarily. In rare cases of chronic forms of lactic acidosis that is caused by mitochondrial disease, a special diet or dicloroacetate might be used. Let’s know more about the condition.

Patients with lactic acidosis suffer from problems in their liver, and sometimes kidney problems too. They might have problems with their liver not being able to remove excess acid from the body.⁽¹⁾ The acidity levels in body fluids like the blood spike if lactic acid builds up in your body more quickly than it can be actually removed. This acidic buildup can result in an imbalance in the pH level of the body, which must always be slightly alkaline, rather than acidic. There is a lactic acid build-up when there is not enough oxygen available in the muscles to break down glucose and glycogen. This is known as anaerobic metabolism.

There are primarily 2 types of lactic acid: L-Lactate and D-Lactate.

Most forms of lactic acidosis are due to excess of L-lactate.

There are 2 types of lactic acidosis, namely, the Type A and Type B.

• Type A: This type of lactic acidosis is caused by tissue hypoperfusion that results from cardiac failure, hypovolemia, sepsis, or cardiopulmonary arrest.
• Type B: This type of lactic acidosis occurs due to an impairment of cellular functioning and localized areas of tissue hypoperfusion.

Below are some of the symptoms of lactic acidosis. If you experience these symptoms, you should take immediate help of your doctor to determine the root cause.

• Confusion
• Fruity-smelling breath
• Jaundice
• Troubled breathing, or rapid breathing.

There might also be some other symptoms of lactic acidosis, which includes, body weakness, muscle cramps or muscle pain, extreme fatigue or exhaustion, diarrhea, headache, overall feelings of physical discomfort, abdominal pain or discomfort, reduced appetite, and rapid heart rate
Causes of Lactic Acidosis:

There are a lot of underlying causes for occurence of lactic acidosis. Some of these causes include carbon monoxide poisoning, malaria, cholera, and asphyxiation. Let us take a look on some more causes of lactic acidosis below.

• Heart Disease: Conditions like congestive heart failure and cardiac arrest might reduce the blood flow and oxygen throughout the person’s body. This can increase the levels of lactic acid.
• Severe Infection or Sepsis: Any type of severe bacterial or viral infection can result in sepsis. Patients with sepsis might experience a spike in their lactic acid, caused by reduced level of oxygen flow.
• Diabetes Mellitus: Lactic acidosis might develop in patients of type 1 and type 2 diabetes mellitus, especially if their diabetes is not controlled well.

There are reports of lactic acidosis in people who take metformin, or a standard non-insulin medicine used for treating type 2 diabetes mellitus. But, the incidence is low, with equal to or less than 10 in 100000 patients- years of using the medication, as per a report of 2014 in the journal named Metabolism.⁽²⁾

There is a higher incidence of lactic acidosis in people with diabetes who also have other conditions, like congestive heart failure and kidney disease. In such people, lactic acidosis indicate a poor prognosis.

Cancer: Lactic acidosis might also be caused in people with cancer. Cancer cells create lactic acid. The lactic acid buildup might accelerate as a person loses weight and there is a progress in the disease.

HIV: HIV medications, like Nucleoside reverse transcriptase inhibitors, can spike the levels of lactic acid. They might also cause liver damage. This makes it more difficult for the body to process lactate.

Short Bowel Syndrome: Though rare, people with short gut might experience a buildup of D-lactic acid, that is caused by bacterial overgrowth in their small bowel.⁽³⁾ Patients who have had gastric bypass surgery might also get D-lactic acidosis.

Chronic Alcoholism: Excessive consumption of alcohol over an extended time period can result in lactic acidosis and alcoholic ketoacidosis.

• Alcoholic ketoacidosis is a fatal condition, especially when left untreated. However, it can be combated with IV hydration and glucose.
• Alcohol increases the levels of phosphate, which impact the kidneys negatively. This makes the pH of your body more acidic. If you have trouble in reducing your alcohol consumption, you should take help of support groups.
• There are evidences connecting excessive alcohol intake to a subtype of lactic acidosis, known as alcohol associated lactic acidosis.
• A higher incidence of alcohol associated lactic acidosis is linked to people who are severely ill, including those with sepsis, which is usually a life-threatening complication of infection.

Use Of Acetaminophen: Regular and frequent use of acetaminophen also causes lactic acidosis, even when taken in the proper dose. This is because it can result in an accumulation of pyroglutamic acid in the patient’s blood.

Intense Exercise Or Physical Activity: A temporary buildup of lactic acid can also be due to vigorous exercise or physical activity, if your body does not have enough oxygen available to break down glucose in the blood. This can result in a burning sensation in the muscles groups you are using. This can also result in weakness and nausea.

Lactic acidosis can be treated by correcting the underlying problem that causes the condition.

First underlying cause of lactic acidosis is being assessed and managed, and there would also be some additional treatments that might be given to support blood circulation and tissue oxygen delivery. Some of the common treatments for lactic acidosis include intravenous fluids to help support blood circulation, oxygen therapy to boost availability of oxygen, and mechanical ventilation for enhancing oxygen delivery to the lungs.Other treatments ,like vitamin therapy and dialysis might be considered.

The best way for treating lactic acidosis is to treat its root cause. So, treatments vary from person to person.

Sometimes this condition represents a medical emergency. This requires treating its symptoms, regardless of their root cause.

For preventing lactic acidosis you should start any exercise routine gradually. Don’t try rapid or intense exercising all of a sudden. Slowly, pace yourself. Begin with an aerobic exercise, such as, running or brisk walking. You can slowly and gradually build your pace and distance. Increase the amount of exercise every week so that your body builds up a tolerance. This would increase the “lactate threshold’ of your body, making it less likely to get lactic acidosis.

Keep in mind that you drink plenty of water as it helps you get rid of any excess acid. Moreover, it is also important for you to consume a balanced diet that includes lots of vegetables, fruits, lean meats, and whole grains. In addition to this, you should also get plenty of sleep at night and also give yourself enough time to recover between bouts of exercise.

You should talk to your doctor if you suspect that lactic acidosis in you is caused by a disease or medicine that you have been taking. You might be able to make certain changes that would help you to avoid the problem. You should also keep it noted to talk to our doctor before beginning a new exercise routine.

Mild and transient elevations in lactate have reduced chances of mortality, while sustained and severe elevations in lactate are linked with a high mortality.⁽⁴⁾

The mortality of lactic acidosis in patients taking metformin was earlier reported to be 50%, however, in more recent reports this was near to 25%.⁽⁵⁾

Lactic acidosis could be a serious condition that could lead to life-threatening complications like shock. So, you need to seek immediate medical care for severe symptoms, like profuse sweating, chest pain, bluish coloration of the lips and nails, cold and clammy skin, rapid heart rate, rapid breathing, weakness, reduced or absent urine output, unusual anxiety, confusion, or unconsciousness.

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