Lactic acidosis causes
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These studies suggest lactic acidosis is caused by increased production or decreased removal of lactic acid, non-hypoxic factors like drugs and toxins, and specific conditions such as diabetes, malaria, and alcohol abuse.
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Causes of Lactic Acidosis: An Overview
Introduction to Lactic Acidosis
Lactic acidosis is a common form of metabolic acidosis characterized by an elevated level of lactate in the blood, typically resulting in a decreased blood pH. It is a critical condition often encountered in intensive care settings and is associated with high mortality rates . Understanding the underlying causes of lactic acidosis is essential for effective diagnosis and treatment.
Biochemical and Metabolic Basis
Lactic acidosis occurs when lactate production exceeds its clearance from the body. Lactate is a byproduct of anaerobic respiration, and its accumulation can result from either increased production or decreased removal . The liver, kidneys, and skeletal muscles play significant roles in lactate clearance, and any dysfunction in these organs can contribute to lactic acidosis .
Classification of Lactic Acidosis
Lactic acidosis is classified into two main types: Type A and Type B.
Type A Lactic Acidosis: Hypoxic Causes
Type A lactic acidosis is primarily due to tissue hypoxia, where the body regenerates ATP without sufficient oxygen. This condition is commonly seen in cases of sepsis, multi-organ failure, circulatory disorders, and severe hypoxia . Hypoperfusion and hypoxia lead to increased anaerobic glycolysis, resulting in elevated lactate levels.
Type B Lactic Acidosis: Non-Hypoxic Causes
Type B lactic acidosis occurs without evidence of tissue hypoxia and can be caused by various factors, including drug side effects, toxins, and metabolic disorders. Conditions such as liver disease, thiamine deficiency, and certain malignancies can impair lactate clearance or increase lactate production . Metformin, a common diabetes medication, has also been implicated in lactic acidosis, particularly in patients with renal or cardiac dysfunction .
Specific Causes of Lactic Acidosis
Sepsis and Multi-Organ Failure
Sepsis and multi-organ failure are leading causes of Type A lactic acidosis. The severe infection and subsequent organ dysfunction result in tissue hypoxia and increased lactate production .
Liver and Kidney Disease
The liver and kidneys are crucial for lactate metabolism. Liver disease can impair gluconeogenesis and lactate clearance, while kidney dysfunction can reduce lactate removal, both contributing to lactic acidosis .
Thiamine Deficiency
Thiamine (vitamin B1) deficiency can lead to lactic acidosis by inhibiting pyruvate dehydrogenase, an enzyme essential for aerobic metabolism. This condition is often seen in patients with chronic alcoholism or malignancies .
Diabetes and Metformin Use
In diabetic patients, lactic acidosis can occur due to various factors, including metformin use, which can impair lactate clearance, especially in those with renal impairment. Alcohol abuse and eating disorders are additional risk factors in this population .
Malaria
Severe malaria can cause lactic acidosis through increased lactate production by Plasmodium parasites and impaired lactate clearance due to liver and kidney dysfunction.
Conclusion
Lactic acidosis is a complex condition with multiple potential causes, ranging from tissue hypoxia to metabolic and drug-related factors. Prompt recognition and treatment of the underlying causes are crucial for improving patient outcomes. Understanding the biochemical and metabolic pathways involved in lactate production and clearance can aid clinicians in diagnosing and managing this critical condition effectively.
Sources and full results
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3
Lactic acidosis update for critical care clinicians.
3
222 Citations
2001