Lactic acidosis: causes, symptoms and treatment of lactic acidosis

Description

Acidosis is usually called an increase in the acidic environment in the blood and tissues of the body compared to the norm, while the pH decreases.
If the shift occurs by 0.3, acidotic coma develops, and by 0.4, death occurs. If a person refuses to eat, so-called internal nutrition begins to occur using secondary tissues and fats. After a while, acidosis reaches maximum levels, ketone cells are converted into amino acids, and an acidotic crisis occurs. Alkalosis is considered to be an increase in alkaline substances in the body with an increase in pH value. If the shift occurs by 0.2, the functioning of all body systems occurs.

Complications

Lactic acidosis poses a serious threat due to the high risk of cerebral edema and death. The likelihood of death increases if medical attention is not provided within hours of the first symptoms occurring. Vascular hypotension and cerebral hypoxia lead to the development of various cerebral disorders and neurological deficits. After the acute period, patients complain of dizziness and chronic headache for a long time. Speech and memory impairments are possible, requiring rehabilitation measures.

Causes

The development of lactic acidosis can be caused by hypoxia that occurs in skeletal muscles due to prolonged physical overexertion. Also, the pathological process can develop with diabetes mellitus, malignant neoplasms, infectious and inflammatory diseases, respiratory failure, myocardial infarction, acute intestinal or lung infarction, renal failure, chronic liver diseases, massive bleeding, severe injuries, chronic alcoholism.

Alkalosis and acidosis can occur due to various reasons, depending on their type. Acidosis appears in diseases that are accompanied by a feverish state, since organic acids are retained in the body. Acetone and acetoacetic acid appear in the urine. In severe cases, coma occurs.

The same type of food and a poor diet, dehydration, and elevated ambient temperatures can also provoke alkalosis. With brain injuries, when vomiting and hypercapnia appear, this pathology also develops. Metabolic alkalosis occurs when the body loses hydrogen ions through excessive vomiting or taking medications that increase diuresis, or long-term intake of mineral water.

Acidosis is a violation of the acid-base balance, in which the acidity of the blood increases and the pH drops below 7.35, hence the accumulation of harmful products in the body and depression of consciousness. The natural ending is coma and then death.

Acidosis itself is not considered a disease; it is a critically dangerous condition, but it is secondary. Refers to a symptomatic complex, a syndrome of a specific disorder.

In some cases, situational surges in acidity are possible, even though they are within the normal range.

In most clinical situations, urgent treatment is required. The underlying disease that caused such a formidable symptom is subject to correction, as well as the elimination of excess acidity, a symptomatic measure.

Both activities take place in a hospital setting, often as part of resuscitation efforts.

Development mechanism

The process has a complex origin. The pathogenesis is based on the inability of the body's buffer systems, primarily blood, to normalize the acidity of the environment. Typically, even healthy people experience pH fluctuations; an adequate value is in the range from 7.35 to 7.38.

Minor deviations in both directions are possible, but short-term. This is also not considered critical.

When the pH drops below 7.35 on a long-term basis, changes in the functioning of organs develop: breathing and cardiac activity suffer, the nervous system is depressed, which ends in death without treatment.

Dynamic balance becomes impossible in a group of disorders. There are several mechanisms for the development of acidosis:

• Excessive acidification of the blood due to the intake of large amounts of gases rich in carbon compounds. For example, when exposed to smoke for a long time, in a stuffy room, with a lack of O2, possibly in high mountains. This is a relatively uncommon cause.
• Hormonal imbalance, accumulation of protein breakdown products in the body. Typically, this problem occurs in patients with diabetes mellitus and severe pathologies of the kidneys and liver.
• The development of a gestational variant of the disorder is possible. They talk about it when the waste products of the fetus poison the mother’s body, when self-regulation and cleansing of the latter is impossible. It occurs mainly in women with somatic pathologies (renal, cardiac, respiratory failure), also in cases of multiple births and severe gestation.

There are other options. Acidosis does not always have a pathological origin. Normally, healthy people experience changes in the acidity of the blood and urine.

There are several reasons for this:

• Intense stress triggers biochemical reactions involving cortisol, adrenaline and others. The result is a temporary pH drop.
• The problem is also observed against the background of excessive physical activity.
• After surgery.
• With an ill-formed diet with a large amount of carbohydrates, protein with a minimum amount of coarse fiber.

Each situation is subject to individual assessment.

Acidosis does not always present pronounced symptoms, especially if the acidity is slightly increased.

But the disorder has the unpleasant property of progressing quickly, within a matter of hours, leading to coma and death. You need to be on your guard.

Classification

The disorder can be divided in several ways. Upon admission of a patient, doctors urgently examine the extent of the disorder. This involves assessing blood and urine.

The types are named according to the criterion:

• Compensated form. Accompanied by relatively normal acidity levels of up to 7.35. There are no symptoms or any signs yet, the patient is completely fine and does not suspect a problem. In this state, acidosis is usually not noticeable and the person is admitted to the hospital for another reason.
• Subcompensation gives a pH level in the range of up to 7.25, which is much more dangerous. The body is still coping, buffer systems partially correct the acidity level, but functional impairments are already present. From the heart, blood vessels, respiratory system. The central nervous system is still normal; headache, nausea, and vomiting are possible. Reflexive, not bringing relief. Without treatment, the pathological condition very quickly moves to the next stage.
• Decompensation of acidosis. Acidity levels are below 7.25, and abnormalities in the functioning of the brain and digestive tract occur. Breathing is shallow, gas exchange is significantly impaired. The phenomena of depression of consciousness and coma are rapidly increasing. Without urgent correction, death cannot be avoided.

Another way to classify acidosis is to evaluate its origin. Without elaborating this criterion, it is impossible to begin quality treatment.

Exogenous form

It is caused by the entry into the body of a large amount of acid in its pure form or substances that can be converted into acid during metabolic processes. If the buffer systems are working properly, the situation is unlikely.

Among the routes of entry of substances, the main one is considered to be nutritional. Food.

Respiratory acidosis

It's gas. It occurs more often and occurs as a result of the ingestion of dangerous mixtures from the surrounding air and environment into the body. For example, when you are in a burning room, there is a lack of oxygen in a room or office.

The same is observed with chest injuries. Carbon dioxide accumulates in the blood, which causes an imbalance in the dynamic balance.

Respiratory acidosis most often leads to rapid changes in the lungs, endocrine system, central nervous system, coma and death.

Excretory form

Accompanied by the inability to remove protein breakdown products and acidic substances due to insufficient filtering function of the kidneys.

The same problem occurs if the concentration of alkaline compounds drops. This often happens with dysfunction of the digestive tract. Recovery involves correction of the main diagnosis.

Associated with insufficient metabolism. Develops against the background of diabetes mellitus and pathologies of infectious origin.

The dysfunctions are deep and systemic. Therefore, treatment may take a little longer.

A special case of the metabolic form of the disorder is lactic acidosis, caused by a drop in insulin levels and, as a result, a complex biochemical reaction with the formation of a large amount of organic acid.

The pathogenesis (origin) is based not on one, but on several factors.

All of these types of acidosis are dangerous and, without treatment, in approximately 87% of cases end in the death of the patient.

Compensated forms can regress on their own, but this does not always happen. There is no need to count on luck.

The clinical picture is determined by the type of disorder.

The respiratory form is characterized by the following manifestations:

• Dizziness. Occurs as a result of insufficient oxygen concentration. Accompanied by disturbance of orientation in space, unsteadiness of gait. In difficult cases, the patient takes a lying position to ease the symptom.
• Shallow shallow breathing. A typical sign of respiratory acidosis. However, such an increase in movements does not lead to compensation; hypoxia (oxygen starvation) increases.
• Change in skin tone to pale. Cyanosis.
• With the long-term existence of the pathological process, the phenomena intensify. Cardiac signs occur: tachycardia, increased number of contractions per minute, arrhythmia. Jumps in blood pressure that are not subject to qualitative correction.
• Objectively, in addition, changes in urea levels are detected, calcium concentration drops, which leads to muscle spasms and cramps.
• In terms of diagnosis, the respiratory form is the simplest; the causes are obvious even with a superficial examination.
• Metabolic acidosis from the beginning gives cardiovascular manifestations:
• Tachycardia. Increase in the number of contractions per minute. At the same time, although the volume of pumped blood increases, the effect is minimal. Because there is not enough oxygen.
• Arrhythmias of other types. When excessive load on the myocardium occurs, group extrasystole or ventricular fibrillation occurs. Which is extremely dangerous. Against the background of such changes, the contractile, pumping function decreases.

• A characteristic symptom of acidosis in adults is increased breathing. The depth of movements increases while the frequency is formally preserved. Based on such a sign of acidosis as the nature of gas exchange, the doctor estimates the type of pathology, this saves time during further examination.
• Dizziness. Inability to navigate in space.
• Nausea and vomiting. Rare. Most often one-time, reflex.
• Impaired consciousness. When the pathological process worsens, all forms of the disorder cause depression of the central nervous system.

At first, this manifests itself as a “wobbly” body, weakness, drowsiness, a decrease in the speed of reaction to stimuli: a call, physical impact, a request, etc. Then loss of consciousness occurs.

Classification

According to the severity of the clinical picture and the severity of the course, three stages of lactic acidosis are distinguished: early, middle and late. Their development occurs extremely quickly, within a few hours the symptoms intensify from general weakness to coma. Another classification is based on the etiopathogenetic mechanisms underlying the complication. According to it, there are two types of hyperlactic acidemia:

• Acquired (type A ).
  Usually debuts after age 35. Caused by a violation of the supply of oxygen and blood to the tissues. Clinical signs characteristic of metabolic acidosis are observed - the functions of the central nervous system are inhibited, the respiratory and heart rate changes. A direct relationship is observed between the level of lactic acidemia and neurological symptoms. With diabetes, there is a high probability of developing shock and a sharp decrease in blood pressure.
• Congenital (type B ).
  It appears from birth, less often from early childhood, and refers to hereditary forms of metabolic disorders. From the first days of life, neurological and respiratory disorders are determined: myotic hypotonicity, areflexia, confusion, dyspnea, polypnea, symptoms characteristic of asthma.

Lactic acidosis

This pathology is accompanied by the accumulation of large amounts of lactic acid in the blood. The disease is of two types: A and B. In the first type, oxygen is completely absent in the tissues, in the second case this is not observed. This disease is inherent in those who have shortening of the small intestine. In this case, bacteria produce not only enzymes and lactic acid, which causes the development of acidosis, which can lead to coma. Lactic acidosis can be caused by leukemia, lymphoma, myeloma, epilepsy, bacteremia, exposure to toxins, and medications.

A complication of diabetes is lactic acidosis, what it is and how to recognize the first signs

Lactic acidosis is a condition of the body in which it accumulates lactic acid, under the influence of a number of reasons.
It can accumulate in a person’s muscles, skin, and brain. As a result of acid accumulation, acidosis changes and takes on the character of metabolic acidosis. During normal life, lactic acid is formed by the body in small quantities; it represents metabolites of metabolic processes.

They are then transformed into lactate, which is further transformed by liver cells into carbon dioxide, water and glucose. With pathology in the processes of processing lactic acid by the liver, the state of lactic acidosis begins to progress.

Let's figure out what kind of disease this is?

Forms of lactic acidosis

The following types of alkalosis are distinguished:

1. Exogenous occurs as a result of the entry into the blood of drugs or substances that increase pH.
2. Respiratory alkalosis occurs when there is increased ventilation of the lungs, which leads to the excretion of large amounts of carbon dioxide. This is observed with brain damage, exposure to toxins and large blood loss.
3. Excretory occurs when gastric juice is lost due to the formation of fistulas in the stomach, incessant vomiting, and in diseases of the kidneys and endocrine system.
4. Metabolic alkalosis occurs when electrolyte metabolism is disrupted. Often observed after operations, in people suffering from rickets.
5. Mixed manifests itself in a combination of several types of alkalosis. Occurs with hypoxia, vomiting, and brain injuries.

With this disorder, a decrease in cerebral blood flow and blood pressure is observed. Nervous and muscle excitability increases, convulsions may develop, and constipation is also observed. Respiratory alkalosis provokes a decrease in mental performance, dizziness and fainting occur, and the activity of the respiratory center decreases.

Symptoms may also include weakness, thirst, lack of appetite, drowsiness, and mental retardation. If help is not provided in time, coma may occur. With metabolic alkalosis, edema may appear, Burnet's syndrome develops, in which apathy, aversion to dairy products, skin itching, conjunctivitis, renal failure develop, and polyuria or polydipsia develops.

This type of disorder provokes lethargy, rapid breathing, a state of stupor and stupor, which can result in shock and death. Sometimes the patient experiences nausea, vomiting, and hyperpnea. With acidosis, there is a high risk of arrhythmia, a decrease in pressure is observed, which can result in disturbances in metabolic processes in the brain.

Also, acidosis, the symptoms and treatment of which we are considering, can provoke dehydration and the formation of heart disease. In its acute form, the disease manifests itself as indigestion, circulatory disorders, and general lethargy.

Therapy in this case should be comprehensive. Treatment should help eliminate the causes of the pathology. Thus, gas alkalosis is treated with mixtures containing carbon dioxide, the patient is given inhalations and Seduxen is prescribed. Non-gas alkaloses are treated depending on their type. Usually they use ammonium, insulin, etc.

In addition to specific treatment for pathologies such as acidosis and blood alkalosis, therapy is prescribed aimed at eliminating concomitant ailments that caused the pathologies.

Lactic acidosis can take an acute form in just a couple of hours and not produce corresponding symptoms.

But basically, the first signs look like this:

• Apathy;
• Rapid breathing;
• Sleep disturbance and lack thereof;
• Drowsiness;
• Muscle pain;
• Pain in the sternum area.

Against the background of acute acidosis, the functioning of the heart is disrupted, and cardiovascular failure manifests itself.

In some cases, an increase in acidosis is accompanied by symptoms such as vomiting and abdominal pain, and deterioration in health. Neurological symptoms are possible: lack of reflexes, paresis (incomplete paralysis), hyperkinesis (involuntary movements of one or a group of muscles).

Loss of consciousness can be a serious precursor to coma. Fainting is preceded by heavy breathing with a characteristic sound. But the characteristic smell of acetone (smells like soaked apples) is absent.

Then the blood pressure drops sharply (collapse), and the blood supply to the internal organs is disrupted. Against this background, the amount of urine excreted by the kidneys decreases and then stops altogether. Subsequently, intravascular coagulation occurs, which provokes the development of thrombosis and hemorrhagic necrosis of the fingers. The skin and mucous membranes may be dry.

Acidification of the body or acidosis (from the Latin acidus - sour) - a shift in the acid-base balance of the body towards increasing acidity (decreasing pH).

Occurs predominantly in adults. Present with various symptoms, depending on the cause and type of condition.

To function, the body needs energy, which it gets from food. Various metabolic processes make energy useful to muscles and organs. During metabolism, waste products accumulate and are excreted by the body through the kidneys, liver, skin, lungs and intestines. These wastes may be acidic or alkaline.

It is important for the body that the blood has a stable pH (hydrogen level). Therefore, the blood usually has a more or less stable pH level between 7.36 and 7.44. This is ensured by various buffer systems that balance the acid-base balance:

• chemical buffering;
• compensation through breathing (so-called respiratory compensation);
• compensation through the kidneys (so-called renal compensation).

Acidic metabolic waste is eliminated by the body through the kidneys, urination, or exhaled through the lungs. If the regulation of acid-base balance is disrupted (for example, as a result of impaired lung or kidney function), excess acid occurs and the body becomes acidic.

Causes of acidosis

Acidification (acidosis) of the body can occur for many reasons, depending on the form. The condition has two acute forms:

• respiratory (breathing) acidosis;
• metabolic (exchange) acidosis.

It occurs due to too shallow breathing or insufficient ventilation of the lungs (so-called hypoventilation). The body exhales too little carbon dioxide (CO₂). Excess acidic carbon dioxide accumulates as bicarbonate in the body.

Noise in the ears and head: causes, treatments, medications

Metabolic acidosis is accompanied by too high concentrations of acidic metabolites in the blood and overload of buffer systems. As a result, the pH drops sharply. This form of acidosis is often life-threatening.

The body is full of acidic substances or constantly receives it in large quantities from the outside (so-called additive acidosis). Possible provoking factors:

• diabetes;
• obesity;
• alcoholism;
• starvation;
• heavy muscular work;
• shock;
• poisoning from methanol (such as in moonshine or counterfeit alcohol), glycol (such as in antifreeze), or salicylates (such as in painkillers such as acetylsalicylic acid).

The body excretes few non-volatile acids by the kidneys (so-called renal or excretory acidosis), which occurs as a result of:

• renal failure.

The introduction of a large amount of acids into the body (mixed acidosis), its triggers are:

• prolonged diarrhea;
• taking carbonic anhydrase inhibitors (a special form of diuretics).

Symptoms of acidosis

Acidosis can have many different symptoms. What the signs of acidification in the body will be depends on why the acid-base balance was disturbed.

Acidification of the body due to respiratory acidosis is the more common form of the disease. It is always associated with so-called hypoxia (oxygen starvation). Reduced oxygen content in the body is manifested by shortness of breath and cyanosis of the lips.

In addition, respiratory acidosis can cause other symptoms, ranging from weakness and confusion to coma. Also, as the kidneys try to resist oxidation in the body, urination increases.

Rare metabolic acidosis (so-called metabolic acidosis), unlike respiratory acidosis, causes completely different symptoms. Typically, intense breathing (hyperventilation) occurs, which is accompanied by unusually deep, noisy breathing (the medical term is Kussmaul breathing).

As a result, the body tries to exhale more acidic carbon dioxide. If diabetes mellitus is the culprit of metabolic acidosis, the patient's breath may smell like acetone.

Additionally, any acute acidosis also affects the heart and blood vessels. If the body is acidic, cardiac output decreases and the blood vessels in the arms and legs dilate. As a result, in case of acidosis, the following additional symptoms are possible:

• low blood pressure;
• arrhythmia;
• loss of consciousness (fainting).

Diagnosis of acidosis

When diagnosing acidosis, it is usually necessary to perform an arterial blood gas analysis (arterial gasometry), and measure the pH and carbon dioxide levels in the blood.

To better understand the cause of acidification in the body, doctors also measure the level of sodium ions in the blood. Next, additional blood tests are prescribed.

Treatment of acidosis

Treatment of acute acidosis has two main goals:

1. Eliminating the causes of excess acid in the body (i.e. treating the underlying disease that caused acidification);
2. Taking immediate measures to relieve acute symptoms of acidosis.

In the case of respiratory acidosis, that is, acidification of the body due to insufficient exhalation of carbon dioxide, symptomatic therapy consists of increasing the respiratory rate to remove acidic carbon dioxide from the lungs.

With respiratory acidosis, due to oxygen starvation (hypoxia), the oxygen content in the organ tissues is completely or partially reduced. Depending on the degree of hypoxia, this affects treatment. In severe cases, artificial pulmonary ventilation (ALV) is required.

With metabolic acidosis, i.e. high concentration of acidic metabolites in the blood, pH drops to 7.15, immediate symptomatic therapy is necessary.

A suitable remedy against high concentrations of metabolic products in the blood is bicarbonate (sodium bicarbonate). If respiratory function is not impaired, the affected person receives bicarbonate through infusion. This way, he will be able to exhale more carbon dioxide (CO₂) through his lungs.

Respiratory acidosis

Types of disease

Depending on the cause of the accumulation of acids in the blood, acidosis is divided into types:

A combined form of acidosis also occurs, especially in patients with chronic metabolic disorders. For example, the risk of acidosis due to high sugar in diabetes is significantly increased by alcohol consumption and diabetic nephropathy.

According to the degree of compensation, acidosis is divided into 3 forms:

• compensated acidosis: symptoms are rare, acidity is close to the lower limit of normal, the condition is stable. No special treatment is required, it is necessary to identify and eliminate the cause of the disorder;
• subcompensated acidosis: borderline condition, observation required;
• decompensated form of metabolic acidosis - blood pH is reduced to life-threatening levels or continues to decrease. Urgent hospitalization, acidity correction with special solutions, and, in some cases, resuscitation measures are required. Without treatment, decompensated acidosis can cause coma and lead to death of the patient.

Criteria for determining the degree of metabolic acidosis:

Clinical picture

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Diagnostics

If there are signs of deterioration in health or the manifestation of specific symptoms, the person should be immediately taken to a medical facility.

Acidosis syndrome is difficult to establish; specific symptoms and a biochemical blood test can help establish the diagnosis.

Lactic acidosis is diagnosed through a blood test in a laboratory. With the syndrome, the level of lactic acid in the blood increases significantly.

At the same time, the levels of reserve alkalinity and bicarbonates decrease. But also increased levels of nitrogen and lipids in the blood serum can also be indicators of complications. Blood biochemistry can indicate an incipient lactic acidosis coma.

The level of such indicators is also determined:

• Bicarbonates;
• Blood sugar level;
• Acetone in urine.

The diagnosis is made based on a blood pH test. It is also important to establish the causes of acidosis. To do this, the doctor interviews the patient, studies his medical history, conducts an examination, and prescribes additional tests.

In addition to blood tests, the pH level is determined in a urine test. In addition, studies of blood gas composition, serum electrolytes and a number of other studies are carried out.

As mentioned above, the symptoms of acidosis are not specific. In addition, they are very often masked by signs of the underlying disease, so the diagnosis cannot always be established immediately.

For an accurate diagnosis, patients undergo the following studies:

• Blood test to determine the pH level in the urine;
• Arterial blood analysis for the presence of serum electrolytes;
• Analysis of arterial blood to determine its gas composition.

The last two studies allow us to determine not only whether a person has acidosis, but also its type (respiratory or metabolic).

A number of additional studies may be needed to determine the cause of acidosis.

If lactic acidosis is suspected, clinical manifestations are taken into account as an auxiliary component. Lactic acidosis can be suspected in any form of metabolic acidosis that is associated with an increased anion gap. In lactic acidosis, the degree of anion gap can vary, but it is never normal.

After blood is collected for biochemical testing, it should be immediately cooled to a temperature of 0 to 4 °C in order to prevent the formation of lactic acid by red blood cells in vitro. To confirm the diagnosis, the concentration of lactic acid in the patient’s blood is determined. In this case, the determination of not only the left-handed, but also the right-handed isomer of lactic acid is of great diagnostic importance. In addition, with lactic acidosis there is a decrease in the content of bicarbonates in the blood and moderate hyperglycemia. There is no acetonuria in this condition.

Differential diagnosis of lactic acidosis is carried out with hypoglycemia of various origins (including glycogenosis), encephalopathy.

Diagnosing alkalosis and acidosis is easy. To do this, urine is tested for pH and blood to determine its gas and electrolyte composition. The diagnosis of alkalosis is based on the patient’s clinical data and determines the presence of chloride in the urine. To detect acidosis, a test using ammonium or calcium chloride is used, and blood and plasma are examined for gas composition and electrolyte levels.

Lactic acidosis: symptoms, treatment, causes, diagnosis

In this article you will learn:

• 1 Reasons
• 2 Symptoms
• 3 Diagnostics
• 4 Treatment

One of the possible causes of death in patients with diabetes mellitus is hyperglycemic coma, which can be ketoacidotic, hyperosmolar or hyperlactic acidotic.

The last option - hyperglycemic hyperlactic acidotic coma (or lactic acidosis, lactic acidosis, lactic acidosis) in diabetes mellitus is quite rare, but the mortality rate in this case is 30-90%.

In general, lactic acidosis is a nonspecific acute complication of diabetes mellitus that develops due to insulin deficiency and the accumulation of large amounts of lactate (lactic acid) in the blood, which leads to severe acidosis and loss of consciousness.

Lactic acidosis often develops in type 2 diabetes mellitus and may be caused by taking metformin. This complication usually occurs at the age of 35–84 years and is often not diagnosed.

Important! It should be remembered that lactic acid is constantly formed in the body of any person and is a normal product of cellular metabolism. Most people are familiar with the condition when, a few days after unusual physical activity, “all the muscles” hurt.

The main reason for this is precisely the excessive accumulation of lactate. In healthy people, lactic acid is gradually used up for the body's needs without any consequences.

However, in diabetes, against the background of prolonged hypoxia, the symptoms of lactic acidosis may increase, up to loss of consciousness.

Taking into account the causes of occurrence, there are two types of lactic acidosis: A and B. Lactic acidosis type A is a consequence of a decrease in tissue oxygen saturation in individuals with initial tissue hypoxia and can develop even in the absence of diabetes mellitus.

The main causes of tissue hypoxia:

• cardiogenic shock;
• endotoxic and hypovolemic shock;
• carbon monoxide poisoning;
• anemia;
• pheochromocytoma;
• epilepsy and others.

Lactic acidosis type B is not associated with initial tissue hypoxia and occurs in the following conditions and diseases:

• diabetes mellitus, especially treated with biguanides (metformin);
• chronic kidney disease;
• liver failure;
• neoplastic processes;
• leukemia;
• alcoholism;
• infectious and inflammatory diseases;
• poisoning with salicylates, cyanides, ethanol, methanol.

As a rule, lactic acidosis develops in the presence of several provoking factors.

The attention of diabetologists to lactic acidosis is due to the fact that it can develop during long-term treatment with biguanides. Especially with liver and kidney damage, even the usual dose of metformin can cause lactic acidosis, the incidence of which, according to various experts, is 2.7–8.4 cases per year per 100,000 patients receiving this drug.

Table - Cases of development of lactic acidosis while taking metformin

However, when prescribed correctly, metformin currently used does not increase the risk of developing lactic acidosis.

The main link in the pathogenesis of lactic acidosis is tissue hypoxia, which activates anaerobic glycolysis and leads to the accumulation of excess lactic acid in the tissues and blood with the development of acidosis and intoxication. Lactate is the final metabolic product of anaerobic glycolysis. At the same time, under hypoxic conditions, the formation of glycogen from lactate in the liver is inhibited.

Blood acidosis

The occurrence of lactic acidosis is also promoted by parenteral administration of liquids containing fructose, sorbitol or xylitol.

Acidosis: what it is, symptoms and treatment of acidosis in adults

Due to the fact that the described condition is the result of a disruption in the functioning of body systems, the goal of treating acidosis is to eliminate the factors that became the trigger. In particular, we are talking about the treatment of underlying diseases, pathological conditions or dysfunctions, which provoked a shift in the acid-base balance of the body.

Correction of severe forms of acidosis involves:

• Elimination of the provoking factor;
• Normalization of hemodynamics: improvement of rheological properties of blood, restoration of microcirculation, elimination of hypovolemia;
• Correction of electrolyte metabolism;
• Elimination of hypoproteinemia;
• Improving renal blood flow;
• Strengthening the hydrocarbonate buffer system;
• Improving oxidative processes in tissues by introducing ascorbic acid, glucose, riboxin, thiamine, insulin, pyridoxine;
• Improving pulmonary ventilation (switching to artificial ventilation in extreme cases).

Targeted correction of the acid-base state by introducing buffer solutions is carried out only at a pH level of less than 7.25 (with decompensated acidosis).

Symptomatic treatment of acidosis involves drinking plenty of fluids, ingesting soda, as well as eliminating associated symptoms (malaise, nausea, arrhythmia, high blood pressure, etc.). In case of poisoning, drugs are prescribed that remove toxic substances from the body; in severe cases, dialysis is performed.

Treatment of acidosis in children is similar to the treatment of this condition in adults.

Emergency care includes intravenous drip administration of 2.5 or 4% sodium bicarbonate solution in a volume of up to 2 liters per day. In this case, blood pH levels and potassium concentrations should be monitored. If necessary, insulin therapy is carried out, plasma-substituting anti-shock drugs are administered intravenously to improve hemodynamics, blood plasma and heparin in low doses to correct hemostasis.

Self-medication at home often leads to death. Therapy is carried out only in a hospital setting.

A dropper of sodium bicarbonate solution will help reduce the acidity of the blood and body tissues.

Intravenous administration of the drug must be carried out under strict control of the blood pH; it must be within normal limits.

Diabetics are given insulin if necessary. To correct hemostasis, heparin and blood plasma are also administered intravenously.

After normalization of the blood condition, the patient is prescribed drugs that improve blood circulation and thrombolytics. Subsequently, a person must support the body for the rest of his life with the help of acetylsalicylic acid and anticoagulants.

Some hypoglycemic drugs can also cause complications, for example, the simultaneous use of medications for viral and colds.

Festered wounds can serve as the initial cause of lactic acidosis.

There are frequent cases when therapy with medications with biguanides, in case of renal failure, became a catalyst for lactic acidosis. This may be due to the accumulation of the drug in the body.

Prevention

Preventive measures are reduced to preventing the state of hypoxia of tissues and organs, as well as treatment and control of diabetes mellitus.

Basically, complications in the form of lactic acidosis are detected in diabetics, so it is important to control the underlying disease and strictly follow all the instructions of the attending physician. Don't let the disease take its course.

It is necessary to periodically take tests and monitor the dynamics of diabetes mellitus in order to adjust the dosage of medications.

A person who has experienced lactic acidosis coma must do everything to avoid provoking such a condition again. After receiving tests that show an increase in lactic acid levels, you should urgently contact an endocrinologist to prescribe appropriate therapy.

If the acidosis is moderate, no specific treatment is prescribed. They only recommend sticking to a diet, excluding protein foods from the diet. In other forms, patients are given intravenous saline solutions and potassium chloride is prescribed. If a patient has adrenal hyperfunction, the underlying disease is treated. In the presence of Barter's syndrome, prostaglandin synthetase inhibitors are used.

Therapy is mainly aimed at preventing the development of anemia, hypovolemia, and correcting the respiratory process. For this, alkali solutions are used. Acidosis is treated with drugs such as Trisamine, Nicotinic acid, Riboflavin, Carnitine, Lipoic acid, and so on. It is also necessary to properly organize your diet and consume foods that help remove toxins from the body.

Treatment consists of eliminating the dysfunction or underlying disease that provoked the development of acidosis.

In the metabolic form of the disease, therapy for metabolic disorders and intravenous fluid administration are indicated. In severe forms of acidosis, solutions containing sodium bicarbonate are prescribed. This is done to increase the pH level in the body to 7.2 or higher.

In addition, solutions of sodium chloride or glucose are used. When severe symptoms appear, measures are taken to relieve them. If acidosis is caused by poisoning of the body, then, first of all, it is necessary to remove toxins.

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• V-Complex;
• Green Formula;
• Calcium/Magnesium Chelate;
• OsteoComplex.

Before using this or that product, you should consult your doctor.

Excretory form

Treatment

If this type of coma occurs or the condition worsens against the background of general well-being, you must immediately call an ambulance or go to the emergency room of the nearest hospital yourself. Independent attempts to cure this condition at home, in most cases, end in failure. The only thing that can help you is to drink enough.

In the hospital, massive infusion therapy is used to eliminate this condition.

The patient is first given one central access, into the subclavian vein, and two peripheral ones. An infusion of sodium bicarbonate and saline solution is performed.

Small doses of insulin are periodically administered, which prevents new portions of lactic acid from leaving the tissues.

Moreover, after the first episode of lactic acidotic coma, patients are forced to take anticoagulants and antiplatelet agents for life.

Prevention of acidosis

First of all, the patient needs to establish a lifestyle, observing sleep and diet. Bad habits should be eliminated; it is recommended to eat fruits and vegetables. This all contributes to the prevention of pathologies such as alkalosis and acidosis. But proper nutrition alone is not enough; moderate physical activity is needed. It is also worth paying attention to the presence of other diseases and treating them in a timely manner so that they do not provoke a change in the acid-base balance of the blood.

Doctors recommend undergoing a medical examination once a year for the purpose of prevention. To balance BER, you need to know that mineral water and milk increase the level of alkalis, while tea and coffee, sweets and meat increase the level of acids. Therefore, such products should be consumed in moderation.

In order to prevent the development of lactic acidosis, it is recommended:

• timely treatment of diseases that may cause lactic acidosis (primarily compensation for diabetes mellitus and prevention of hypoxia), compliance with all instructions of the attending physician;
• avoiding uncontrolled use of drugs;
• increasing immunity;
• rejection of bad habits;
• avoiding physical and mental stress.

At the first sign of lactic acidosis, you should immediately seek medical help.

Acidosis, the symptoms and treatments for which are described above, can be prevented. To reduce the likelihood of developing the disease, the following recommendations must be followed:

• Healthy food;
• to refuse from bad habits;
• drink enough fluids;
• control the hardness and quality of drinking water;
• promptly treat pathologies associated with metabolic disorders;
• lead an active lifestyle, engage in physical exercise;
• do not abuse caffeine-containing drinks;
• timely sanitization of foci of chronic infection in the body;
• undergo regular preventive examinations of the body.

Health to you!

What it is?

Lactate acidosis is a complication of type 2 diabetes mellitus. When the pancreas malfunctions, accompanied by insulin resistance, this causes metabolic disturbances throughout the body.

This is the start for the development of complications and, as a result, almost all organs and systems of the body begin to suffer.

Lactic acidosis occurs in diabetic nephropathy. Against the background of kidney pathology, they are unable to remove toxic products from the body, thereby harmful metabolites begin to accumulate, leading to self-destruction of the body, resulting in the accumulation of lactic acid.

The body and pH

We already know the concept of acidosis and alkalosis. But can the body protect itself from an imbalance of acids and alkalis in the blood? The human body has super-efficient mechanisms that monitor pH levels. These mechanisms include the buffer and respiratory systems, as well as the kidneys. The buffer system is able to instantly return the pH level to normal because it is able to absorb and release hydrogen ions in case of deficiency or excess.

The respiratory system works through the respiratory brain centers, which are able to speed up or slow down breathing depending on the concentration of carbon dioxide in the blood. The kidneys are able to maintain the balance of acids and alkalis by absorbing, retaining and excreting them. All these mechanisms are independent of environmental influences, but in some human diseases they fail.

Thus, every chemical reaction that occurs in the human body is affected by the accumulation of hydrogen ions in it. The more it is in the blood, the lower the pH level, and the less it is, the higher the pH becomes. For the body to function properly, the accumulation of hydrogen ions must be within normal limits, since small fluctuations can negatively affect health.

Symptoms of lactic acidosis

For acquired lactic acidemia, acute development is typical, the full clinical picture unfolds in 6-18 hours. There are usually no warning symptoms. At the first stage, acidosis manifests itself nonspecifically: patients note general weakness, apathy, muscle and chest pain, digestive disorders in the form of vomiting, loose stools, and abdominal pain. The middle stage is accompanied by an increase in the amount of lactate, against which the phenomena of pulmonary hyperventilation occur. The gas exchange function of the lungs is disrupted, and carbon dioxide accumulates in the circulatory system. Changes in respiratory function are called Kussmaul breathing. There is an alternation of rare rhythmic cycles with deep breaths and heavy noisy exhalations.