Have you ever felt tired, achy, or short of breath when you're a little tired? These could be due to a number of reasons. However, today we're going to talk about a condition that can occur when a chemical called lactic acid builds up in our bodies. This is what doctors call lactic acidosis . Don't worry, let's talk about this simply.
What is Lactic Acidosis?
Simply put, lactic acidosis is a condition where there is too much lactic acid in your blood. This can happen when your body produces too much lactic acid, or when your body is unable to properly remove the lactic acid it produces.
Normally, our liver and kidneys are the ones that remove the excess lactic acid from our bodies. However, if the amount of lactic acid is too high, or if there is some weakness in these organs like the liver and kidneys, they cannot do this job properly. That is when lactic acid starts to accumulate in the blood.
When the level of lactic acid in your blood is slightly elevated, we call it hyperlactatemia . However, if this increases further and the body's pH (i.e. acid-base balance) becomes too acidic, that's called lactic acidosis .
Why does lactic acid form in our body?
Lactic acid, sometimes called lactate , is a natural byproduct of cellular metabolism. Our cells use glucose (sugar) to produce energy. This process is called anaerobic glycolysis . This happens when cells need energy quickly, but they don't have enough oxygen to do so.
Normally, we get energy through a process that uses oxygen. This is called aerobic metabolism . However, anaerobic glycolysis is like an energy source that we use in emergencies. Imagine, when you suddenly run hard or lift a heavy weight, your muscles suddenly lack oxygen. That's when this method is used. Similarly, when our tissues do not receive oxygen due to some diseases, lactic acid is also produced in this way.
What happens when lactic acidosis occurs?
What happens when you have lactic acidosis depends on its severity. Some people may experience this condition temporarily, especially after heavy exercise. It can make your body ache for a few days. But if your liver and kidneys are in good health, the lactic acid will go away in a few days.
However, if your body continues to produce too much lactic acid, or if your liver and kidneys are unable to process it properly, the situation can become more serious. This often happens with some kind of illness. As the lactate level in your blood continues to rise, the pH level decreases, and the cardiac output gradually decreases. This can lead to other organ failure and even death. So it's important to be aware of this.
What are the symptoms of Lactic Acidosis?
The symptoms of this condition may vary in the early stages and when the condition becomes severe.
Early symptoms
At first, you may feel things like this:
- Nausea and vomiting.
- Extreme fatigue and exhaustion.
- Rapid, deep breathing (this is called respiratory compensation , an attempt to reduce the acidity of the body through breathing).
- Muscle twitching and body pain.
Symptoms when the condition becomes serious
As the condition worsens, the following symptoms may also appear:
- Weakness and increased drowsiness.
- Delirium and confusion.
- Difficulty controlling movements, such as when walking ( ataxia ).
- Decreased urine output ( Oliguria ).
Other symptoms
You may also have symptoms of an underlying medical condition that is causing lactic acidosis . For example, conditions such as sepsis ( a blood infection), shock ( a stroke), or liver failure . Symptoms of this may include:
- Low body temperature.
- Low blood pressure.
- Fever.
- Jaundice (yellowing of the skin and whites of the eyes).
What is the main cause of lactic acidosis?
There can be many reasons for this. The most common cause is low oxygen levels in your blood (hypoxemia) or a lack of oxygen to your tissues (hypoxia). This is usually caused by a medical condition.
Doctors have divided this condition of lactic acidosis into several types based on its causes:
Type A
Type A lactic acidosis occurs when your tissues don't get enough oxygen. It's often seen in severe medical conditions. It can also be temporary, caused by excessive exercise.
Some conditions that can cause excessive lactate production include:
- Pulmonary disorders cause the blood to not receive enough oxygen.
- Circulatory disorders cause slow blood flow and a lack of oxygen to the tissues.
- Hemoglobin disorders affect the ability of red blood cells to carry oxygen.
- Shock conditions such as septic shock , hypovolemic shock, or cardiogenic shock .
- Intestinal ischemic syndrome .
- Prolonged seizures and convulsions.
- Carbon monoxide poisoning.
Type B
Type B lactic acidosis occurs without hypoxemia or hypoxia . There are three subtypes.
Type B1
This is caused by underlying diseases that interfere with the ability to metabolize lactate.
They can be:
- Liver disease .
- Kidney disease .
- Thiamine (vitamin B1) deficiency.
- Cancer.
- HIV/AIDS status.
- Mitochondrial diseases .
- Diabetes- related ketoacidosis.
- Alcohol addiction ( Alcohol use disorder ).
Type B2
This occurs as a side effect of some medications and toxins. Examples:
- Cyanide poisoning.
- Carbon monoxide poisoning.
- Alcohol poisoning.
- Cocaine use.
- Some medications for HIV ( Nucleoside reverse transcriptase inhibitors (antiretroviral therapy) ).
- Some types of inhalers used for diseases such as asthma ( Beta-adrenergic agonist inhalers ).
- Epinephrine injection for severe allergies.
- The antibiotic linezolid .
- Propofol for anesthesia.
- Metformin, a drug used for diabetes (this is widely used in Sri Lanka, so you should be especially aware of this).
Type B3
This is caused by congenital deficiencies of specific enzymes needed to metabolize lactate. These are very rare. Examples:
- Glycogen storage disease .
- Fructose-1,6-diphosphatase deficiency .
- Pyruvate carboxylase deficiency .
- Pyruvate dehydrogenase deficiency .
- Oxidative phosphorylation deficiency .
- Methylmalonic aciduria .
D-lactic acidosis
The types A and B we talked about earlier are related to the accumulation of L-lactate in your blood. This L-lactate is a type of lactic acid that is normally produced and metabolized in the human body.
However, there is another very rare type of lactic acidosis, which is caused by the accumulation of D-lactate . This type of lactic acid is produced by a type of bacteria in your large intestine. D-lactate is produced as a byproduct when these bacteria metabolize carbohydrates during digestion.
D-lactic acidosis occurs when these bacteria overgrow. The excess D-lactate is then absorbed from the intestines into the blood. D-lactate cannot be metabolized by our kidneys or liver. So it continues to accumulate in the blood. This is often seen as a complication of a condition called short gut syndrome .
How is Lactic Acidosis diagnosed?
Doctors determine whether you have lactic acidosis based on the following factors:
- Blood lactate levels greater than 4 mmol/L (millimoles per liter).
- Blood pH less than 7.35.
These values are measured by taking a blood sample from you and testing it.
What tests are done for this?
The following tests are performed to diagnose lactic acidosis :
- Comprehensive metabolic panel (CMP) : This is a simple blood test that measures various things in your blood to get basic information about your health.
- Blood lactate test : In addition to the things measured in the CMP, the lactate level in your blood is specifically measured.
- Anion gap blood test : This test measures the pH and electrolyte balance of your blood.
- Arterial blood gas test : This measures the oxygen saturation of your arteries, as well as the pH and electrolyte balance.
How is Lactic Acidosis treated?
If you have lactic acidosis due to a temporary cause, such as excessive exercise, shaking, or a seizure, it will usually resolve over time. You can get relief by staying home and staying hydrated.
However, in a hospital setting, lactic acidosis is treated immediately with intravenous fluids ( IV fluids , that's what we call saline) and other resuscitation treatments, such as oxygen therapy , if necessary.
Treatment will then be determined based on the cause. Depending on your symptoms, your medical team will work to treat the underlying medical condition or poisoning that is causing the lactic acidosis .
If you are showing symptoms of low oxygen levels, the medical team will suspect Type A causes – such as cardiac or respiratory failure, sepsis , or shock – and treat those emergencies first.
In cases where low oxygen levels are not indicated, they consider the various causes of type B and treat them specifically.
What kind of results can someone with lactic acidosis expect?
The results depend on the cause and severity of the condition. Type A lactic acidosis – which is associated with sepsis , shock, and/or reduced oxygen delivery to the blood – is more serious. Other types of lactic acidosis may be milder and develop more slowly, allowing more time and opportunity for treatment.
In general, as blood lactate levels increase, mortality rates may increase. However, full recovery is possible with prompt and effective treatment.
Lactic acidosis is one of several conditions called metabolic acidosis, in which acid builds up in your blood. In metabolic acidosis , the body's normal metabolic processes that produce and manage acid are disrupted in some way. Normally, your liver and kidneys can filter out excess acid. But when those organs aren't working properly, they're less able to manage acidosis. So, taking care of your liver and kidneys by drinking plenty of water, limiting alcohol and taking harmful medications can go a long way toward maintaining your long-term health.
Brief points to remember
Okay, so let's remind you of some of the most important things we talked about today:
- Lactic acidosis is an increase in lactic acid in the blood.
- There can be many reasons for this. The main reason is that the body is not getting enough oxygen.
- Initial symptoms may include extreme fatigue, vomiting, and rapid breathing.
- Blood tests are done to diagnose this condition.
- Treatment depends on the cause. Sometimes rest and fluids are enough, sometimes hospitalization is required.
- If diagnosed and treated early, it can be cured.
- Keeping the liver and kidneys healthy helps protect against conditions like these.
So, if you have any of these symptoms, or if you want to know more about this, don't forget to consult a doctor. Stay healthy!
` Lactic acidosis, lactic acidosis, lactate, blood acidity, body acid balance, exercise, health
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