Lactic acidosis in extreme athletes

In rare cases, it can also lead to lactic acidosis in extreme athletes, since, above a certain threshold, the metabolism resorts to anaerobic energy production (without oxygen) during heavy physical exertion. This is a physiological and normally harmless process, but if this happens to an extreme degree, it can lead to lactic acidosis. In this case, it is usually sufficient as therapy if the athlete spares himself for a while and takes breaks between the sporting activity so that the metabolism can return to normal.

Indications

The symptoms of lactic acidosis can vary greatly. They include nausea, vomiting, abdominal pain, faster breathing, tachycardia and a change in mental state can also occur. In addition, anxiety, fatigue, irregular heart rate, lethargy and weakness are symptoms that one must expect in a case of lactic acidosis.

A typical sign of lactic acidosis is also the so-called kissing mouth breathing. It serves to compensate for the overacidification of the body.It is a deep and regular breathing, where the body tries to breathe out the excess acid in the form of carbon dioxide. In addition, restlessness, shortness of breath, fever and circulatory problems are often experienced. Patients often become conspicuous in the further course of the disease through increasing confusion and clouding of consciousness up to coma.

The course of lactate acidosis

The course of a lactic acidosis can be different. It is a very rare disease and much also depends on the triggering cause. In professional and extreme athletes, the disease usually subsides completely again when appropriate rest periods are used. If the cause is an organ disorder, especially in the kidney and liver, the probability of a fatal lactic acidosis is highest.

Consequences/Complications

In severe cases, lactic acidosis can lead to shock, including life-threatening kidney failure. If the lactic acidosis is due to organ damage, such as kidney or liver damage, it can also be fatal. In this case medical help should be contacted immediately.

Signs of lactic acidosis in the critical stage are: blue-colored lips or fingernails, changes in nature and state of consciousness (fainting, listlessness), chest pain, chest pressure, palpitations, high fever (higher than 38.5° Celsius), breathing problems (shortness of breath, rapid breathing, respiratory arrest) and severe abdominal pain. In case of these symptoms, an emergency call should be made immediately, otherwise serious health problems or even death may result. In recent years, the number of deaths following the use of antibiotics containing metformin has increased in Europe.

Experts counted 37 deaths in the last ten years, 29 of which were due to lactate acidosis. The exact mechanism of action has not been clarified and therefore one should always clarify whether one can take the drug and what to look for. In the 70s and 80s similar drugs were taken off the market due to frequent deaths after taking them.

Metformin is the last antidiabetic drug still on the market. Metformin is an antidiabetic drug which belongs to the biguanide class. It blocks the transport of electrons in the respiratory chain, resulting in less oxygen being produced and the anaerobic metabolism, i.e. the lactate-producing metabolism, being driven.

Patients with impaired liver function are particularly at risk of developing lactic acidosis when treated with metformin. In addition to the respiratory chain, metformin probably also inhibits gluconeogenesis (formation of glucose) in the liver. Lactate is used as a building block for this metabolic pathway.

By inhibiting gluconeogenesis, more lactate accumulates, which is more difficult for a damaged liver to eliminate than a healthy liver. Lactate acidosis can also occur in cases of impaired kidney function, as metformin is excreted via the kidneys. If kidney function is restricted, the drug is excreted more slowly and plasma levels are elevated.

This results in a longer efficacy of the drug, which can further increase the lactate levels. Because of this connection, all patients will have their kidney values checked before the prescription of metformin. A contraindication exists if the creatinine level is at least 1.5mg/dl in men and 1.4mg/dl in women and if the creatinine clearance is below 60ml/min. Lactic acidosis caused by metformin is associated with increased mortality. 30% of patients die from it.