If the lactate level in the blood rises, with a simultaneous drop in the acid-base balance, the so-called lactic acidosis occurs. Lack of oxygen, muscle work or even shock conditions, pulmonary embolisms as well as surgery can trigger that hyperacidity.
What is lactic acidosis?
In the context of lactic acidosis, the lactic acid concentration in the blood increases. The pH subsequently falls below the physiological range, with acidic levels shifting as a result. Such a change may well have serious consequences. Depending on the cause, even the health and life of the affected person may be at risk.
Causes
Individuals affected by lactic acidosis have too much lactate (lactic acid) in their blood; subsequently, hyperacidity occurs. The causes are manifold. On the one hand, lactic acidosis can be triggered by medication (for example, as part of diabetes mellitus treatment); on the other hand, kidney dysfunction or even liver insufficiency can trigger lactic acidosis. Sepsis (blood poisoning) can also cause lactic acidosis. Other causes are pulmonary embolisms, shock or even surgery, which can also trigger hyperacidity of the body. Lactic acidosis can also occur in extreme athletes, if the body has to develop too much muscular strength. However, that cause is not serious; it is enough to rest so that the values “calm down” again.
Symptoms, complaints and signs
Lactic acidosis can cause various symptoms and complaints. Typical signs include vomiting, nausea, palpitations, abdominal pain, and rapid breathing, fatigue, anxiety, lethargy, and weakness. In many cases, an irregular heart rate also occurs. A classic symptom is kissing-mouth breathing. That breathing provides compensation in the context of hyperacidity. The “kissing-mouth breathing” is characterized by very deep and regular breathing, where the body is busy breathing off the excess acid. Sometimes shortness of breath, restlessness as well as also fever can occur. As the disease progresses, confusion, impaired consciousness or even unconsciousness (coma) are also possible. However, lactic acidosis can have such severe effects on the body and its organs that the acidosis can also lead to the death of the affected person. Especially if not treated, the patient risks his life and sometimes dies – due to lactic acidosis.
Diagnosis and course of the disease
A medical professional can only diagnose lactic acidosis by means of a laboratory test. Lactic acidosis occurs when the pH is less than 7.36, while at the same time the concentration of lactate exceeds a value of more than 5 mmol/l. If only a low pH value is present, with the concentration of lactate in the normal range, the physician speaks of metabolic acidosis. No other diagnosis is possible. The course of lactic acidosis varies. Above all, the reason why lactic acidosis has occurred plays an essential role. If lactic acidosis occurs in extreme athletes, the symptoms subside when the athlete takes a rest. However, if organ dysfunction is responsible for lactic acidosis, especially if the liver and kidney are affected, the patient’s life is in acute danger. The patient may go into a coma; sometimes death may occur as part of that cause.
Complications
As a result of lactic acidosis, affected individuals suffer from various serious medical conditions. In the worst case, these complaints can also lead to the death of the patient and should therefore be treated in any case. Patients suffer from palpitations and nausea. Likewise, there is a general weakness and fatigue of the patient. Lactic acidosis also significantly reduces the patient’s ability to cope with stress. Furthermore, a heart attack or sudden cardiac death may also occur. Unconsciousness or other disturbances of consciousness can also occur and significantly reduce the patient’s quality of life. Likewise, inner restlessness and severe shortness of breath occur. If treatment of lactic acidosis does not occur, the patient usually dies. Lactic acidosis is usually treated with the help of medication.These can alleviate and reduce the discomfort so that those affected can return to a normal daily routine. As a rule, no particular complications occur. If lactic acidosis is successfully treated, the patient’s life expectancy is also not affected.
When should you see a doctor?
If various unusual symptoms occur after taking medication or after a surgical procedure, a doctor should be consulted. In case of nausea, vomiting, a feeling of malaise and abnormalities and irregularities of the heart rhythm, a doctor should be consulted. Severe fatigue, diffuse anxiety or apathy are signs that need to be investigated. If sweating, internal weakness and loss of appetite occur, a physician should be consulted. If there is fever, a lethargic demeanor, or a feeling of illness, a physician is needed. Dizziness, unsteadiness of gait, mood swings, and an increase in existing inconsistencies should be examined by a physician. A disturbance in breathing, a feeling of oxygen deprivation despite an adequate supply of fresh air, and states of confusion are considered warning signs of the organism. In the case of “kissing mouth breathing”, the affected person shows a very characteristic sign of lactic acidosis. A visit to the doctor is necessary so that a diagnosis can be made after various tests and examinations. If the above-mentioned symptoms occur after a strong muscular activity, a doctor should be consulted to clarify the cause. If the affected person suffers loss of consciousness, an emergency doctor should be called as soon as possible. Because failure to treat lactic acidosis can lead to an early demise, timely examination of the affected individual is advised. Delays may also result in irreparable organ damage.
Treatment and therapy
As a rule, lactic acidosis is treated in hospital (inpatient), with the patient being admitted to the intensive care unit. This is because continuous monitoring must be possible until the circulation is stable. In order to lower the acid concentration in the body, physicians also administer bicarbonate as an antidote. Even if at the beginning mainly the symptoms of lactic acidosis are treated, subsequently it is also necessary to pay attention to which cause is responsible and then treat the triggering factor. In this case, the alkaline/alkaline bicarbonate is administered, which should neutralize the hyperacidity in the body. It is important that the lactic acid production is also slowed down or stopped completely. Only in this way is it possible for the body to break down the lactate. Therefore, care should be taken that the bicarbonate is used carefully. Sometimes this agent can also aggravate hyperacidity. If there are signs that the agent does not bring the desired success, the therapy must be stopped immediately. As an alternative treatment method – either right at the beginning or after the therapy with bicarbonate has not brought the desired effect – different liquids can be injected. These are intended to improve the oxygen supply to the patient, so that the production of lactate can be counteracted. By means of oxygen therapy, it is possible for the patient to be provided with sufficient oxygen again or for the body of the affected person to be able to regenerate. If lactic acidosis develops due to a diabetic derailment, the patient is injected with insulin. In this way, the blood sugar level can be lowered again. Vitamin therapies or even dialysis treatments also purify the overacidified blood. However, if the liver is irreversibly damaged, so that lactic acidosis is subsequently triggered, only a liver transplant can provide relief. In the case of liver damage, only the symptoms are primarily treated; the cause treatment can only be performed when an organ is available for transplantation.
Outlook and prognosis
The course of the disease as well as the prognosis of lactic acidosis depend on the causative disorder. If left untreated and without consulting a physician, an unfavorable course may result in myocardial infarction or sudden cardiac death. If the symptoms occur as a side effect due to the administration of medication, a change in the original treatment plan can already bring about freedom from symptoms. The prescribed drugs should be checked for their ingredients.Subsequently, alternative preparations are to be identified and applied. Immediately after discontinuation of the triggering medication, relief of the symptoms is seen and, in the further course, recovery. In the case of an existing organ disorder, it is necessary to check how far it has progressed and how severe the damage to the organ is. In most cases, the organ damage is irreversible and can lead to a failure of organ activity in the case of a severe course of the disease. This represents a potential threat to human life. For many patients, only organ transplantation can ultimately provide relief. The procedure is complex and associated with numerous complications. If lactic acidosis occurs in conjunction with diabetes, the treatment plan must be reviewed. Blood glucose levels must be monitored and optimizations must take place. Blood acidosis can be normalized in dialysis treatment.
Prevention
In almost all cases, it is possible for lactic acidosis to be prevented. It is important that medications be taken only if the liver and kidneys are in full working order. Taking medications even though the organs are damaged can inevitably lead to lactic acidosis.
Follow-up
The measures of aftercare prove to be relatively difficult in most cases of lactic acidosis, so a doctor should be consulted quickly in the first place for this disease. Self-cure cannot occur and the symptoms of lactic acidosis usually continue to worsen if the disease is not treated properly. Therefore, the affected person should seek medical attention at the first signs and symptoms. In most cases, sufferers are thereby dependent on taking various medications. Care should always be taken to ensure that the dosage is correct and that the medication is taken regularly. Likewise, the doctor’s instructions should always be followed. If there are any uncertainties or questions, a doctor should be consulted first. Since most of those affected by lactic acidosis are also dependent on dialysis, the help and support of their own family and friends is often necessary. In many cases, this can also prevent depression or other psychological upsets. Likewise, a healthy lifestyle with a healthy diet has a positive effect on the course of the disease, and a diet plan can also be drawn up by a doctor.
What you can do yourself
After lactic acidosis has been treated with intensive care, the patient must take it easy. Recovery can be aided by monitoring the mode of action of the prescribed bicarbonate and informing the physician if unusual symptoms occur. The active ingredient often does not have the desired effect and must then be discontinued or adjusted differently. Anyone who experiences side effects or interactions should first make a note of these in a complaints diary and then contact the doctor responsible as soon as possible to discuss further steps. Finally, the cause of the lactic acidosis must be determined. Often a diabetic derailment underlies the condition, which can be prevented by preparation and changes in lifestyle. In addition, alternative measures such as vitamin therapy are available, some of which are carried out by patients at home. If lactic acidosis necessitates liver transplantation, measures must be taken to quickly find a donor organ. For this purpose, the patient should contact a specialized clinic and at the same time search for a suitable donor among acquaintances or via online portals. After a transplant, rest and bed rest again apply. In parallel, the responsible physician must monitor the state of health.
