Lactic acidosis. Causes of lactic acidosis. Lactic acidosis (Hyperlactic acidemia, Lactic acidemia, Lactic acid coma, Lactic acidosis) What is lactic acidosis

Lactic acidosis in diabetes develops quite rarely. But at the same time, the accumulation of lactic acid in the body is very dangerous. If treatment is not started on time, the consequences can be disastrous.

Lactic acidosis is one of the rare complications of diabetes mellitus, which can occur when there is an excess of lactic acid in the body. The condition is very dangerous and rapidly developing. Failure to provide timely medical care leads to lactic acidotic coma and death. To provide timely assistance for a condition such as lactic acidosis in diabetes, it is simply necessary to know the symptoms.

Symptoms of the development of lactic acidosis

This complication develops over several hours. The main symptoms are:

  • drop in blood pressure;
  • weakness;
  • cardiovascular failure;
  • symptoms of pulmonary hyperventilation;
  • heaviness in the limbs;
  • nausea and vomiting;
  • heart rhythm disturbance;
  • rapid breathing;
  • pain in the abdomen and behind the sternum.

These symptoms are similar to a significant increase in blood sugar. The condition of ketoacidosis also falls under these symptoms.

The main difference between them is the presence of muscle pain, as after physical training. There is no pain with ketoacidosis.

If a patient with diabetes complains of muscle pain, it is worth measuring the blood sugar level and monitoring the person’s condition. A sharp deterioration in health, the presence of these symptoms indicates lactic acidosis. We need to call an ambulance. It is impossible to provide first aid yourself.

Causes of lactic acidemia


Lactic acidosis can develop while taking certain antihyperglycemic drugs. These medications often contain the substance biguanide. This ingredient prevents the liver from destroying excess lactate. If there is an excess of lactate in the human body, a lactic coma may develop.

The accumulation of lactic acid in the tissues of the body occurs due to oxygen starvation of the tissues, which, in turn, leads to a decrease in the pH level in the blood.

Diseases that are characterized by hypoxia can provoke lactic acidemia. These are diseases of the cardiovascular system. When combined with diabetes, the risk of lactic acidosis increases.

One of the reasons for the development of lactic coma may be a metabolic failure. Lactic acid coma practically does not develop in children with diabetes.

Diagnosis of lactic acidosis

Diagnosis is made by health care providers based on symptoms and a blood test to calculate lactic acid levels. The lactic acid level exceeds 2.0 mmol/l, and the blood pH is below 7.0 - this is lactic acidemia.

Treatment methods


Treatment of lactic acidosis in diabetes mellitus is carried out in intensive care and includes the following measures:

  • intravenous administration of sodium bicarbonate;
  • administration of methylene blue to relieve coma;
  • use of the drug trisamin – eliminates hyperlactacidemia;
  • hemodialysis when the pH level in the blood decreases<7,0;
  • administration of a solution of insulin with glucose in small doses, but often, reduces the level of lactic acid;
  • hyperventilation of the lungs to remove excess carbon dioxide;
  • gastric lavage and the use of sorbents to reduce the concentration of biguanide.

Having coped with the coma state, they begin to carry out anti-shock measures. During treatment, the patient's blood pressure, pH and blood sugar levels are constantly measured, and an electrocardiogram is performed.

Unfortunately, these measures are only effective in half the cases. An organism weakened by cardiovascular and other diseases rarely recovers. Death occurs from respiratory arrest or acute heart failure.

Prevention of lactic acidosis

The main measure to prevent lactic acidosis is adequate and attentive treatment for diabetes. Timely visits to the doctor, replacing medications with more effective ones, regularly measuring blood sugar levels are the main points. General preventive measures for diabetes will help you maintain your health.

Diet


The diet should be rich in vegetables, lactic acid products, and low-sugar fruits. Not recommended for use:

  • cereals;
  • bakery products;
  • sweet fruits.

You will have to exclude alcohol, sugar, sausage, and fruit juices containing sugar. Freshly squeezed juices are allowed in small quantities. A meal schedule is important. It should be given precisely at the same time every day, just like insulin injection.

Medicines

  1. The tablets should be taken at the same time every day. Independent replacement or discontinuation of medications is prohibited. Only a doctor can make such changes.
  2. Inject insulin in different places so that the injection in the same place is not repeated often. Keep the area where the drug is administered clean.

Physical activity and daily routine

  1. Moderate physical activity. Walking, cleaning, light running - contribute to better absorption of glucose.
  2. Strict daily routine. Work, rest, getting up, taking medications are done at a certain time.
  3. Don't overwork yourself mentally and physically.

special instructions

  1. Carry a diabetes card with you.
  2. Try not to get sick with viral diseases. Complications can lead to a coma.
  3. Always have candy or a few pieces of sugar with you in case of hypoglycemia.
  4. Visit your doctor regularly and take the necessary tests.
  5. Pay attention to alarming symptoms and seek medical help as soon as possible.

By adhering to these rules, you can live a normal, fulfilling life for many years.

What is lactic acidosis and what symptoms does this complication of diabetes mellitus have - questions that can most often be heard from endocrinologist patients. Patients suffering from type 2 diabetes mellitus most often ask this question.

Lactic acidosis in diabetes mellitus is a fairly rare complication of the disease. The development of lactic acidosis in diabetes is caused by the accumulation of lactic acid in the cells of organs and tissues under the influence of intense physical activity on the body or when a person is exposed to corresponding unfavorable factors that provoke the development of complications.

Detection of lactic acidosis in diabetes is carried out by laboratory detection of lactic acid in human blood. Lactic acidosis has the main symptom - the concentration of lactic acid in the blood is more than 4 mmol/l and the ion interval ≥ 10.

In a healthy person, lactic acid is produced in small quantities every day as a result of metabolic processes occurring in the body. This compound is quickly processed by the body into lactate, which, upon entering the liver, undergoes further processing. Through several processing steps, lactate is converted into carbon dioxide and water or glucose with simultaneous regeneration of the bicarbonate anion.

If lactic acid accumulates in the body, lactate stops being excreted and processed by the liver. This situation leads to the fact that a person begins to develop lactic acidosis.

For a healthy person, the amount of lactic acid in the blood should not exceed 1.5–2 mmol/l.

Causes of lactic acidosis

Most often, lactic acidosis develops in type 2 diabetes mellitus in patients who have suffered a myocardial infarction or stroke as a result of the underlying disease.

The main reasons that contribute to the development of lactic acidosis in the body are the following:

  • oxygen starvation of tissues and organs of the body;
  • development of anemia;
  • bleeding leading to large blood loss;
  • serious liver damage;
  • the presence of renal failure developing while taking metformin, if the first symptom from the specified list is present;
  • high and excessive physical stress on the body;
  • the occurrence of shock or sepsis;
  • cardiac arrest;
  • the presence of uncontrolled diabetes mellitus in the body, even if a diabetic antihyperglycemic drug is taken;
  • the presence of some diabetic complications in the body.

The occurrence of pathology can be diagnosed in healthy people due to the impact of certain conditions on the human body and in patients with diabetes.

Most often, lactic acidosis develops in diabetics against the background of uncontrolled diabetes mellitus.

For a diabetic, this state of the body is extremely undesirable and dangerous, since in this situation a lactic acidotic coma can develop.

Lactic acid coma can be fatal.

Symptoms and signs of complications

Sugar level

Symptoms and signs of lactic acidosis in diabetes may include the following:

  • disturbance of consciousness;
  • feeling of dizziness;
  • loss of consciousness;
  • the appearance of a feeling of nausea;
  • the appearance of the urge to vomit and vomiting itself;
  • frequent and deep breathing;
  • the appearance of pain in the abdomen;
  • the appearance of severe weakness throughout the body;
  • decreased physical activity;
  • development of deep lactic acid coma.

If a person has the second type of diabetes mellitus, then falling into a lactic coma is observed some time after the first signs of the development of complications appear.

When a patient falls into a comatose state, he experiences:

  1. hyperventilation;
  2. increased glycemia;
  3. decrease in the amount of bicarbonates in the blood plasma and decrease in blood pH;
  4. a small amount of ketones is detected in urine;
  5. the level of lactic acid in the patient’s body rises to 6.0 mmol/l.

The development of the complication is quite acute and the condition of a person with type 2 diabetes mellitus worsens gradually over several hours in a row.

The symptoms accompanying the development of this complication are similar to the symptoms of other complications, and a patient with diabetes mellitus is able to fall into a coma with both low and high levels of sugar in the body.

All diagnosis of lactic acidosis is based on a laboratory blood test.

Treatment and prevention of lactic acidosis in the presence of diabetes mellitus

Due to the fact that this complication primarily develops from a lack of oxygen in the body, therapeutic measures to remove a person from this condition are primarily based on the scheme of saturating the cells of human tissues and organs with oxygen. An artificial lung ventilation device is used for this purpose.

When removing a person from a state of lactic acidosis, the doctor’s first priority is to eliminate the hypoxia that has arisen in the body, since it is precisely this that is the root cause of the development of lactic acidosis.

During the implementation of treatment measures, blood pressure and all vital signs of the body are monitored. Special monitoring is carried out when removing lactic acidosis from elderly people who suffer from arterial hypertension and have complications and disorders in the liver.

Before diagnosing lactic acidosis, a patient's blood must be taken for analysis. During laboratory testing, the pH of the blood and the concentration of potassium ions in it are determined.

All procedures are carried out very quickly, since the mortality rate from the development of such a complication in the patient’s body is very high, and the duration of the transition from a normal state to a pathological one is short.

If severe cases are detected, potassium bicarbonate is administered; this drug should be administered only if the blood acidity is less than 7. Administration of the drug without the results of an appropriate analysis is strictly prohibited.

The patient's blood acidity is checked every two hours. The introduction of potassium bicarbonate should be carried out until the medium has an acidity exceeding 7.0.

If the patient has renal failure, kidney hemodialysis is performed. Additionally, peritoneal dialysis may be performed to restore normal levels of potassium bicarbonate in the body.

In the process of removing the patient’s body from an acidotic state, adequate insulin therapy is also used, the purpose of which is to correct carbohydrate metabolism.

Without a biochemical blood test, it is impossible to reliably diagnose the patient. To prevent the development of a pathological condition, it is necessary to take the patient to a medical facility when the first signs of pathology appear and carry out the necessary studies.

In order to prevent the development of lactic acidosis in the body, the state of carbohydrate metabolism in the body of a patient with diabetes should be strictly monitored. The video in this article will tell you about the first signs of diabetes.

Lactic acidosis I Lactic acidosis (lactat-acidosis: synonym: lactic acid, lactic acidemia)

a pathological condition that occurs in various diseases and syndromes, when the content of lactic acid in the blood serum persistently exceeds 5 mmol/l, which is associated with a decrease in arterial blood pH. It is caused by both increased formation of lactate and insufficient utilization of it in the liver and kidneys, especially due to disruption of the process of gluconeogenesis. The main producers of lactate in the body include muscles, the medulla of the kidneys, intestines, eyes and (potentially) tumors, and consumers include the kidneys, where lactate is either converted back to glucose through the process of gluconeogenesis, or is completely oxidized in the citric acid cycle. . There is also an additional, backup way to remove lactate from the blood by the kidneys when the threshold level of its content is exceeded, equal to 7 mmol/l. Lactate is the end product of anaerobic glucose metabolism through the glycolytic pathway and is in equilibrium with pyruvate through a reaction catalyzed by the enzyme lactate dehydrogenase. Pyruvate is called a “cross-metabolite,” emphasizing its central role in many metabolic processes. When oxygenation in the liver is impaired as a result of inhibition of the activity of the pyruvate dehydrogenase multienzyme complex, lactate is formed from pyruvate instead of acetyl-CoA. In addition, as a result of reduced oxygenation, the amount formed is not enough to cover the energy needs of the gluconeogenesis process, due to which accumulated lactate is normally utilized in the body.

According to the generally accepted clinical classification of Cohen-Woods (1976), there are two types of lactic acidosis - A and B. Type A includes acquired L.-a., the cause of which is a violation of the supply of tissues with oxygen or blood; to lactic acidosis type B - hereditary forms of metabolic disorders caused by birth defects, which are noted at the level of key enzymes of gluconeogenesis or pyruvate catabolism (see Hereditary diseases , Enzymopathies) , in this case, peripheral circulation is usually not affected.

The factors leading to the occurrence of acquired L.-a. are varied. In some cases, a temporary asymptomatic increase in the level of lactate in the blood serum is possible, which is caused by a spontaneous metabolic disorder, for example, with excessive intake of carbohydrates, emotional stress, alcohol intoxication, after heavy physical exertion or convulsions. Pronounced L.-a. can develop with respiratory distress syndrome: heart diseases complicated by circulatory failure, operations with artificial circulation; cardiogenic, hypovolemic or septic shock with disseminated intravascular coagulation; in patients with extensive retroperitoneal tumors and in cancer patients on total parenteral nutrition; in case of poisoning with medicinal and some other substances (methanol, calcium, sodium and ammonium chloride). L.-a. also observed in comatose states of various etiologies; may develop during the treatment of patients with diabetes mellitus with sugar-lowering drugs in tablets (biguanides, especially phenformin), which is due to the blockade of lactate utilization by the liver with these drugs and stimulation of its production in the periphery.

Excess lactate penetrates through the active transport mechanism, which increases its concentration in the brain by approximately 3-4 times compared to its normal plasma content of 1.0-1.8 mmol/l. It is believed that high concentrations of lactate in the brain matter have a neurotoxic effect on it. However, there is an opinion that high concentrations of lactate in the brain arise as a result of focal ischemia or pathological processes that themselves directly disrupt the oxidative central nervous system.

Clinical picture of acquired L.-a. characterized by symptoms of metabolic acidosis - depression of the central nervous system, impaired breathing, dysfunction of the cardiovascular system and urination (see Acidosis) . There is a close relationship between the level of hyperlactic acidemia and neurological disorders. diabetic L.-a. the same as diabetic ketoacidosis or any other severe metabolic acidosis, with the exception of L-a. accompanied, as a rule, by arterial hypotension with the possible development of shock.

Lactic acidosis type B is characterized by the appearance from the first days of a child’s life of respiratory (polypnea, asthma-like conditions) and neurological (muscular, areflexia, unstable, episodes of impaired consciousness of varying severity) disorders, refusal of food, repeated abdominal pain, increase in size liver, sometimes on the skin. Subsequently, there is a delay in physical and mental development. Congenital L.-a., for example, with biotin-dependent carboxylase deficiency, can manifest itself at a later date.

Diagnosis of L.-a. based only on significantly varying clinical symptoms is very difficult. It is based on the results of laboratory data: arterial blood pH is below 7.3. base deficiency, high lactate and (or) pyruvate in the blood, indicating gluconeogenesis. In specialized centers it is possible to make a specific enzymatic diagnosis.

For all forms of L.-a. large quantities of liquid and sodium bicarbonate are indicated. Dichloroacetate, which activates the pyruvate dehydrogenase enzyme complex, as well as lipoic acid preparations, are prescribed. With L.-a. type A is simultaneously carried out by the underlying disease. So, with diabetic L.-a. with blood glucose levels above 13.9 mmol/l even in the absence of ketoacidosis or hyperosmolarity, low-dose insulin may be effective. With congenital clinical symptoms of L.-a. type B requires correction of acidotic changes in acid-base balance. Then the diet is corrected: in case of gluconeogenesis disorders, frequent feeding of carbohydrate-rich foods is effective; if pyruvate oxidation is impaired, they should make up 70% of the daily caloric intake of food.

Prognosis for L.-a. type A depends on the underlying disease, the severity of lactic acidemia, the timeliness and adequacy of infusion therapy. It may be unfavorable if complications develop (eg, cerebral edema, signs of transtentorial cerebral herniation, or persistent coma). With L.-a. Type B is usually unfavorable.

II Lactic acidosis (lactat-acidosis; lat. acidum lacticum + Acidosis; .:, lactic acidemia)

a pathological condition characterized by the accumulation of lactic acid in the blood.

1. Small medical encyclopedia. - M.: Medical encyclopedia. 1991-96 2. First aid. - M.: Great Russian Encyclopedia. 1994 3. Encyclopedic Dictionary of Medical Terms. - M.: Soviet Encyclopedia. - 1982-1984.

See what “Lactic acidosis” is in other dictionaries:

    - (lactat acidosis; lat. acidum lacticum lactic acid + acidosis; synonym: lactic acidosis, lactic acidemia) a pathological condition characterized by the accumulation of lactic acid in the blood ... Large medical dictionary

    lactic acidosis- y, h. Impaired metabolism of acids, which is characterized by accumulation of lactic acid in the blood. Recession of lactate/acid/recession of illness, the development of which leads to the accumulation of lactic acid in the body... Ukrainian Tlumach Dictionary

    - (lactat acidosis hereditaria; synonym lactate acidosis of newborns) a hereditary disease caused by metabolic disorders in the Krebs cycle with the accumulation of lactic acid in the body, characterized by respiratory disorders (polypnea, dyspnea, ... ... Large medical dictionary

    - (lactat acidosis neonatorum) see Lactate acidosis hereditary... Large medical dictionary

    I Acidosis (acidosis; lat. acidus sour + ōsis) one of the forms of disturbances in the acid-base balance of the body; characterized by an absolute or relative excess of acids, i.e. substances that donate hydrogen ions (protons) to bases... Medical encyclopedia

    ACIDOSIS- – a violation of the acid-base state of the body, characterized by an absolute or relative excess of acids and a decrease in pH. Acidosis can be compensated or uncompensated depending on the pH of the internal environment of the body. At… … Encyclopedic Dictionary of Psychology and Pedagogy

    See Lactate acidosis... Large medical dictionary

    Active ingredient ›› Sodium lactate solution complex [Potassium chloride + Calcium chloride + Sodium chloride + Sodium lactate] (Compound solution of sodium lactate) Latin... ...

    - (enzyme[s] (Enzymes) + Greek pathos suffering, disease; synonymous with enzymopathy) diseases and pathological conditions caused by the complete absence of enzyme synthesis or persistent functional deficiency of enzyme systems of organs and tissues.… … Medical encyclopedia

    Active ingredient ›› Fructose* (Fructose*) Latin name Levulose ATX: ›› V06DC02 Fructose Pharmacological groups: Detoxifying agents, including antidotes ›› Agents for enteral and parenteral nutrition ›› Plasma substitutes and... ... Dictionary of medicines

Diabetes mellitus is an endocrine pathology that is fraught with a number of acute and chronic complications. Disruption of metabolic processes that occurs against the background of insulin resistance causes a malfunction of all vital organs and systems.

One of the dangerous problems is the development of kidney failure. The result is a violation of the excretory function, stagnation of harmful substances in the body. Against the background of hyperglycemia, compensatory forces are launched in the form of self-destruction of glucose and the accumulation of large amounts of lactic acid in the blood, which does not have time to be excreted due to a kidney problem. This condition is called lactic acidosis. It requires immediate correction and can lead to the development of lactic acidotic coma.

General information

Lactic acidosis in type 2 diabetes is not a common condition, however, it is very serious. A favorable outcome is observed only in 10-50% of cases. Lactate (lactic acid) appears in the body due to the breakdown of glucose, but the kidneys are not able to remove it in such large quantities.


Laboratory diagnostic results are the basis for confirming the diagnosis

Oversaturation of arterial blood with lactate leads to a shift in its acidity. The diagnosis is confirmed by determining the level of lactic acid above 4 mmol/l. The second name for this complication in diabetes is lactic acidosis.

Important! Normal levels of lactic acid for venous blood (mEq/l) are 1.5-2.2, and for arterial blood - 0.5-1.6.

Main reasons

Lactic acidosis in type 2 diabetes mellitus does not occur in all patients, but only under the influence of certain provoking factors:

  • pathology of metabolic processes of a hereditary nature;
  • introduction of a significant amount of fructose into the body, bypassing the gastrointestinal tract;
  • alcohol poisoning;
  • mechanical damage;
  • bleeding;
  • inflammatory, infectious diseases;
  • cyanide poisoning, long-term use of salicylates, biguanides;
  • diabetes mellitus that cannot be controlled with medications, in combination with other complications;
  • hypovitaminosis B1;
  • severe form of anemia.

Pathology can develop not only against the background of the “sweet disease”, but also after a heart attack or stroke.

Development mechanism

After carbohydrates enter the human body through the gastrointestinal tract, the process of their breakdown lasts in several stages. If insufficient insulin is produced (this happens in the later stages of type 2 disease when pancreatic cells are depleted), the breakdown of carbohydrates into water and energy occurs much more slowly than necessary and is accompanied by the accumulation of pyruvate.

Due to the fact that the quantitative indicators of pyruvate become high, lactic acid accumulates in the blood. It tends to affect the functioning of internal organs in a toxic manner.


Lactic acid molecule is a substance whose accumulation in the body leads to the development of lactic acidosis.

The result is the development of hypoxia, that is, the cells and tissues of the body will not receive enough oxygen, which further aggravates the state of acidosis. This blood pH level causes insulin to lose its activity even more, and lactic acid levels rise higher and higher.

With the progression of the pathological condition, it is formed, accompanied by intoxication of the body, dehydration and acidosis. Such manifestations can be fatal.

Manifestations

Symptoms of lactic acidosis increase over several hours. Typically the patient complains of the following clinical picture:

  • headache;
  • dizziness;
  • attacks of nausea and vomiting;
  • disturbance of consciousness;
  • painful sensations in the abdomen;
  • impairment of motor activity;
  • muscle pain;
  • drowsiness or, conversely, insomnia;
  • frequent loud breathing.

Such symptoms are not specific, since they can be observed not only with the accumulation of lactic acid, but also against the background of a number of other complications.

Important! Later, signs of disorders of the heart and blood vessels appear, as well as neurological symptoms (lack of physiological reflexes, development of paresis).

Coma is a sign of reaching the last stage in the development of lactic acidosis. It is preceded by a deterioration in the patient's condition, severe weakness, dry skin and mucous membranes, Kussmaul breathing (noisy rapid breathing with a preserved rhythm). The tone of the patient's eyeballs decreases, body temperature drops to 35.2-35.5 degrees. Facial features become sharpened, eyes are sunken, and there is no urine output. Next, loss of consciousness occurs.


The development of coma is the final stage of complications in diabetes mellitus

The process may be aggravated by the development of disseminated intravascular coagulation syndrome. This is a condition in which intravascular blood coagulation and massive blood clot formation occur.

Diagnostics

Diagnosing pathology is quite difficult. As a rule, the condition is confirmed by laboratory tests. There is a high level of lactate and plasma anion gap in the blood. The development of pathology is evidenced by the following points:

  • lactate levels above 2 mmol/l;
  • quantitative indicators of bicarbonates are less than 10 mmol/l, which is almost half the norm;
  • the level of nitrogen and its derivatives in the blood increases;
  • lactic acid levels are 10 times higher than pyruvic acid levels;
  • the fat level is significantly increased;
  • blood acidity is below 7.3.

Help and patient management tactics

Medical care should be aimed at combating changes in blood acidity, shock, and electrolyte imbalances. At the same time, endocrinologists carry out corrections in the treatment of type 2 diabetes mellitus.

Important! Hemodialysis is considered the most effective way to eliminate excess lactic acid.

Since a significant amount of carbon monoxide is formed against the background of impaired blood acidity, this problem should be eliminated. The patient is hyperventilated (if the patient is unconscious, then intubation is necessary).

Glucose with short-acting insulin (to correct metabolic disorders due to the diabetic process), and a solution of sodium bicarbonate are injected into a vein. Vasotonics and cardiotonics (drugs to support the functioning of the heart and blood vessels) are prescribed; heparin and rheopolyglucin are administered in small doses. Using laboratory diagnostics, blood acidity and potassium levels are monitored.


Carrying out massive infusion is an important part of the treatment of diabetic lactic acidosis

It is impossible to treat a patient at home, since even highly qualified specialists cannot always have time to provide assistance to the patient. After stabilizing the condition, it is important to maintain bed rest, a strict diet, and constantly monitor blood pressure, acidity, and blood sugar.

Prevention

As a rule, it is impossible to predict the development of lactic acidosis in type 2 diabetes mellitus. The patient’s life depends on those people who surround him at the time the complication develops, and the qualifications of the medical personnel who arrive on demand.

To prevent the development of pathology, you should strictly follow the advice of your treating endocrinologist and take prescribed glucose-lowering medications in a timely manner and in the exact dosage. If you miss a pill, you do not need to take twice the dose next time. You should drink the amount of the drug that was prescribed for one dose.

During diseases of infectious or viral origin, the diabetic’s body may react in unexpected ways to the medications taken. When the first signs of the disease appear, you should contact your doctor to adjust the dosage and treatment regimen.

It is important to remember that lactic acidosis is not a disease that will “go away on its own.” Timely seeking help is the key to a favorable outcome.

Lactic acidosis is also called lactic acidosis. This condition, which provokes hyperlactic acidemic coma, is a dangerous complication that is relevant for diabetes mellitus.

Lactic acidosis occurs as lactic acid accumulates in the human body. The following are susceptible to this:

  • Skeletal muscles,
  • Leather,
  • Brain.

After a certain amount of acid accumulates, lactic acidosis transforms into metabolic acidosis.

It is extremely important for all people with lactic acidosis to know the main symptoms of lactic acidosis.

Causes of lactic acidosis

Lactic acidosis occurs due to:

  1. Inflammatory and infectious diseases,
  2. Massive type bleeding,
  3. Alcoholism in chronic form,
  4. Acute myocardial infarction,
  5. Severe physical injuries,
  6. Kidney failure
  7. Chronic liver diseases.

The key factor causing lactic acidosis is taking biguanides, for example, Metformin is often taken. In this case, symptoms of lactic acidosis appear in patients with diabetes mellitus who are taking glucose-lowering medications containing this substance.

If the kidneys or liver are affected, even a minimal dose of biguanides can cause lactic acidosis. This condition is caused by the accumulation of drugs in the body.

Lactic acidosis occurs due to hypoxia of skeletal muscles. Hypoxia can appear, for example, with prolonged physical stress. This will also require medication.

If there is no obvious presence of hypoxia, then the cause of the condition may be leukemia and several other tumor processes. Other reasons could be:

  • Respiratory failure
  • Acute infarction of one of the lungs,
  • intestinal infarction,
  • Thiamine deficiency in the body.

Important signs of lactic acidosis

Lactic acidosis most often enters an acute form, almost within a few hours. Typically, symptoms may be completely absent, but treatment is necessary.

Patients note muscle pain and discomfort appearing behind the sternum. Lactic acidosis has the following symptoms:

  • apathy,
  • increased breathing,
  • insomnia,
  • drowsiness.

Manifestations of cardiovascular insufficiency are classic symptoms of severe acidosis. This disorder provokes the contractility characteristic of the myocardium while lactic acidosis develops.

After this, lactic acidosis provokes a progressive deterioration of the general condition, in which, due to the increase in acidosis, the stomach begins to hurt and vomiting is observed.

If the patient's condition is significantly worsened by lactic acidosis, then the symptoms can be very diverse: from areflexia to paresis and hyperkenesis.

Immediately before the onset of coma, which is accompanied by loss of consciousness, the patient begins to experience noisy breathing with barely audible breath sounds. The characteristic odor of acetone does not cause lactic acidosis. Typically, this type of breathing occurs with metabolic acidosis.

Over time, lactic acidosis begins to manifest symptoms of collapse. Oligoanuria appears first, and then anuria. As a result, the development of DIC syndrome - intravascular coagulation - begins. If these conditions are detected, the doctor should immediately provide treatment.

Lactic acidosis symptoms include the appearance of intravascular thrombosis with hemorrhagic necrosis of the toes and hands.

Please note how quickly lactic acidosis forms; formation occurs in just a few hours.

Signs of the condition include:

  • dryness of the mucous membrane of the tongue,
  • dryness of the membranes,
  • dry skin.

Treatment and diagnostic measures for lactic acidosis

Diagnosis of lactic acidosis with all the above symptoms is quite difficult to determine. Symptoms are taken into account as an auxiliary component.

Laboratory data have satisfactory reliability, based on the determination of lactic acid in the blood. In addition, the following indicators are determined:

  • decrease in blood bicarbonates,
  • degree of moderation of hyperglycemia,
  • absence of acetonuria.

When considering the symptoms of lactic acidosis and the condition itself, it is necessary, first of all, to determine the indications for the prompt elimination of hypoxia.

For symptoms of the condition and lactic acidosis itself, emergency care consists of intravenous administration of a solution of sodium bicarbonate (4% or 2.5%) in a volume of up to 2 liters per day.

Metformin is taken for diabetes; it reduces hyperglycemia, but does not develop hypoglycemia. Unlike sulfonylurea derivatives, which include, Metformin does not stimulate insulin production.

In case of an overdose of Metformin in diabetes, lactic acidosis may develop with a potentially fatal outcome. The reason is the accumulation of the drug due to impaired renal function.

If signs of lactic acidosis appear, it is better to stop using Metformin. The patient needs to be hospitalized urgently. Metformin is best at eliminating hemodialysis in medical settings. In addition, symptomatic treatment is carried out.

Hypoglycemia may develop if Metformin is taken together with sulfonylureas.

It is important to monitor pH levels and potassium levels in the blood.

In addition, for lactic acidosis and symptoms, active genetically engineered insulin therapy or monocomponent therapy with “short” insulin are used as treatment.

In the treatment of symptoms and lactic acidosis, carboxylase can also be used intravenously by drip method with the introduction of about 200 mg per day.

Treatment consists of intravenous administration of blood plasma and a small amount of heparin, which helps correct hemostasis.

Prevention of coma

To prevent lactic acidemic coma due to lactic acidosis, it is necessary to prevent hypoxia and rationalize control over the course of diabetes mellitus.

Lactic acidosis, the symptoms of which may appear with the use of biguanides, requires determination of their doses for rapid withdrawal during intercurrent diseases, for example, pneumonia.

Lactic acidosis has symptoms when suppuration processes appear, so diabetics need to take this into account when consuming biguanides when performing treatment.

If you have any suspicions hinting at lactic acidosis, you should immediately consult an endocrinologist.

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