Lactic Acidosis

aciltip-10-2-kapak-wos

Cansel YAŞARa , Ramiz YAZICIb

aAnkara Bilkent City Hospital, Clinic of Emergency Medicine, Ankara, Türkiye
aUniversity of Health Sciences Kanuni Sultan Süleyman Training and Research Hospital, Clinic of Emergency Medicine, İstanbul, Türkiye

ABSTRACT
Lactate levels above 2 mmol/L represent hyperlactatemia, whereas lactic acidosis is usually defined as a serum lactate concentration above 4 mmol/L (usually serum pH below 7.35). Lactic acidosis is the most common cause of metabolic acidosis in hospitalised patients. Lactic acidosis occurs when lactic acid production exceeds lactic acid clearance. The increase in lactate production is usually due to impaired tissue oxygenation resulting from reduced oxygen delivery or a defect in mitochondrial oxygen utilisation. Lactic acidosis occurs by 3 mechanisms: 1. Increased glycolysis 2. Decreased lactic acid metabolism (abnormal TCA cycle) 3. Increased glycolysis or abnormal TCA cycle. Primary treatment is the diagnosis and treatment of the underlying disease. Tissue hypoxia can significantly increase lactic acid production and often slows down the metabolism of lactate by the liver, heart, and kidneys. When using bicarbonate therapy in patients with lactic acidosis and severe acidemia, the aim is to maintain arterial pH above 7.1 until the primary process causing metabolic acidosis is reversed. However, if the patient has severe acute kidney injury, the aim is to increase the pH above 7.3.
Keywords: Acidosis, lactic; sodium bicarbonate; lactic acid; mitochondria

Referanslar

  1. Rose BD, Post TW. Clinical Physiology of Acid-Base and Electrolyte Disorders. 5th ed. New York: McGraw-Hill; 2001. p.583.
  2. Buchalter SE, Crain MR, Kreisberg R. Regulation of lactate metabolism in vivo. Diabetes Metab Rev. 1989;5(4):379-91. [Crossref]  [PubMed]
  3. Madias NE. Lactic acidosis. Kidney Int. 1986;29(3):752-74. [Crossref]  [PubMed]
  4. Kreisberg RA. Lactate homeostasis and lactic acidosis. Ann Intern Med. 1980;92(2 Pt 1):227-37. [Crossref]  [PubMed]
  5. Kreisberg RA. Lactic acidosis: An update. J İntensive Care Med. 1987;2(2):76-84. [Crossref]
  6. Kreisberg RA. Pathogenesis and management of lactic acidosis. Annu Rev Med. 1984;35:181-93. [Crossref]  [PubMed]
  7. Mizock BA. Controversies in lactic acidosis. Implications in critically ill patients. JAMA. 1987;258(4):497-501. [Crossref]  [PubMed]
  8. Fulop M, Horowitz M, Aberman A, Jaffe ER. Lactic acidosis in pulmonary edema due to left ventricular failure. Ann Intern Med. 1973;79(2):180-6. [Crossref]  [PubMed]
  9. Weil MH, Afifi AA. Experimental and clinical studies on lactate and pyruvate as indicators of the severity of acute circulatory failure (shock). Circulation. 1970;41(6):989-1001. [Crossref]  [PubMed]
  10. Wrenn KD, Slovis CM, Minion GE, Rutkowski R. The syndrome of alcoholic ketoacidosis. Am J Med. 1991;91(2):119-28. [Crossref]  [PubMed]
  11. Uribarri J, Oh MS, Carroll HJ. D-lactic acidosis. A review of clinical presentation, biochemical features, and pathophysiologic mechanisms. Medicine (Baltimore). 1998;77(2):73-82. [Crossref]  [PubMed]
  12. Lu J, Zello GA, Randell E, Adeli K, Krahn J, Meng QH. Closing the anion gap: contribution of D-lactate to diabetic ketoacidosis. Clin Chim Acta. 2011;412(3-4):286-91. [Crossref]  [PubMed]
  13. Sillos EM, Shenep JL, Burghen GA, Pui CH, Behm FG, Sandlund JT. Lactic acidosis: a metabolic complication of hematologic malignancies: case report and review of the literature. Cancer. 2001;92(9):2237-46. [Crossref]  [PubMed]
  14. Fraley DS, Adler S, Bruns FJ, Zett B. Stimulation of lactate production by administration of bicarbonate in a patient with a solid neoplasm and lactic acidosis. N Engl J Med. 1980;303(19):1100-2. [Crossref]  [PubMed]
  15. Nadiminti Y, Wang JC, Chou SY, Pineles E, Tobin MS. Lactic acidosis associated with Hodgkin's disease: response to chemotherapy. N Engl J Med. 1980;303(1):15-7. [Crossref]  [PubMed]
  16. Rice K, Schwartz SH. Lactic acidosis with small cell carcinoma. Rapid response to chemotherapy. Am J Med. 1985;79(4):501-3. [Crossref]  [PubMed]
  17. Friedenberg AS, Brandoff DE, Schiffman FJ. Type B lactic acidosis as a severe metabolic complication in lymphoma and leukemia: a case series from a single institution and literature review. Medicine (Baltimore). 2007;86(4):225-32. [Crossref]  [PubMed]
  18. Sia P, Plumb TJ, Fillaus JA. Type B lactic acidosis associated with multiple myeloma. Am J Kidney Dis. 2013;62(3):633-7. [Crossref]  [PubMed]
  19. Dhup S, Dadhich RK, Porporato PE, Sonveaux P. Multiple biological activities of lactic acid in cancer: influences on tumor growth, angiogenesis and metastasis. Curr Pharm Des. 2012;18(10):1319-30. [Crossref]  [PubMed]
  20. Pernet P, Bénéteau-Burnat B, Vaubourdolle M, Maury E, Offenstadt G. False elevation of blood lactate reveals ethylene glycol poisoning. Am J Emerg Med. 2009;27(1):132.e1-132.e2. [Crossref]  [PubMed]
  21. Wallia R, Greenberg A, Piraino B, Mitro R, Puschett JB. Serum electrolyte patterns in end-stage renal disease. Am J Kidney Dis. 1986;8(2):98-104. [Crossref]  [PubMed]
  22. Day NP, Phu NH, Bethell DP, Mai NT, Chau TT, Hien TT, White NJ. The effects of dopamine and adrenaline infusions on acid-base balance and systemic haemodynamics in severe infection. Lancet. 1996;348(9022):219-23. Erratum in: Lancet 1996;348(9031):902. [Crossref]  [PubMed]
  23. Madias NE, Goorno WE, Herson S. Severe lactic acidosis as a presenting feature of pheochromocytoma. Am J Kidney Dis. 1987;10(3):250-3. [Crossref]  [PubMed]
  24. Dodda VR, Spiro P. Can albuterol be blamed for lactic acidosis? Respir Care. 2012;57(12):2115-8. [Crossref]  [PubMed]
  25. Lau E, Mazer J, Carino G. Inhaled β-agonist therapy and respiratory muscle fatigue as under-recognised causes of lactic acidosis. BMJ Case Rep. 2013;2013:bcr2013201015. [Crossref]  [PubMed]  [PMC]
  26. Stacpoole PW. Lactic acidosis and other mitochondrial disorders. Metabolism. 1997;46(3):306-21. [Crossref]  [PubMed]
  27. Santa KM. Treatment options for mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome. Pharmacotherapy. 2010;30(11):1179-96. [Crossref]  [PubMed]
  28. Centers for Disease Control and Prevention (CDC). Lactic acidosis traced to thiamine deficiency related to nationwide shortage of multivitamins for total parenteral nutrition -- United States, 1997. MMWR Morb Mortal Wkly Rep. 1997;46(23):523-8.
  29. Salvatori G, Mondì V, Piersigilli F, Capolupo I, Pannone V, Vici CD, et al. Thiamine Deficiency in a Developed Country: Acute Lactic Acidosis in Two Neonates Due to Unsupplemented Parenteral Nutrition. JPEN J Parenter Enteral Nutr. 2016;40(6):886-9. [Crossref]  [PubMed]
  30. Kam PC, Cardone D. Propofol infusion syndrome. Anaesthesia. 2007;62(7):690-701. [Crossref]  [PubMed]
  31. Velez JC, Janech MG. A case of lactic acidosis induced by linezolid. Nat Rev Nephrol. 2010;6(4):236-42. [Crossref]  [PubMed]
  32. Cope TE, McFarland R, Schaefer A. Rapid-onset, linezolid-induced lactic acidosis in MELAS. Mitochondrion. 2011;11(6):992-3. [Crossref]  [PubMed]
  33. Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, et al.; Early Goal-Directed Therapy Collaborative Group. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345(19):1368-77. [Crossref]  [PubMed]
  34. Uribarri J, Oh MS, Carroll HJ. D-lactic acidosis. A review of clinical presentation, biochemical features, and pathophysiologic mechanisms. Medicine (Baltimore). 1998;77(2):73-82. [Crossref]  [PubMed]
  35. Stolberg L, Rolfe R, Gitlin N, Merritt J, Mann L Jr, Linder J, Finegold S. d-Lactic acidosis due to abnormal gut flora: diagnosis and treatment of two cases. N Engl J Med. 1982;306(22):1344-8. [Crossref]  [PubMed]
  36. Oh MS, Uribarri J, Carroll HJ. Electrolyte case vignette: a case of unusual organic acidosis. Am J Kidney Dis. 1988;11(1):80-2. [Crossref]  [PubMed]
  37. Kraut JA, Kurtz I. Use of base in the treatment of severe acidemic states. Am J Kidney Dis. 2001;38(4):703-27. [Crossref]  [PubMed]
  38. Stacpoole PW. Lactic acidosis: the case against bicarbonate therapy. Ann Intern Med. 1986;105(2):276-9. [Crossref]  [PubMed]
  39. Mathieu D, Neviere R, Billard V, Fleyfel M, Wattel F. Effects of bicarbonate therapy on hemodynamics and tissue oxygenation in patients with lactic acidosis: a prospective, controlled clinical study. Crit Care Med. 1991;19(11):1352-6. [Crossref]  [PubMed]
  40. Al-Abri SA, Kearney T. Baking soda misuse as a home remedy: case experience of the California Poison Control System. J Clin Pharm Ther. 2014;39(1):73-7. [Crossref]  [PubMed]
  41. Jaber S, Paugam C, Futier E, Lefrant JY, Lasocki S, Lescot T, et al.; BICAR-ICU Study Group. Sodium bicarbonate therapy for patients with severe metabolic acidaemia in the intensive care unit (BICAR-ICU): a multicentre, open-label, randomised controlled, phase 3 trial. Lancet. 2018;392(10141):31-40. Erratum in: Lancet. 2018;392(10163):2440. [Crossref]  [PubMed]
  42. Weil MH, Rackow EC, Trevino R, Grundler W, Falk JL, Griffel MI. Difference in acid-base state between venous and arterial blood during cardiopulmonary resuscitation. N Engl J Med. 1986;315(3):153-6. [Crossref]  [PubMed]
  43. Adrogué HJ, Rashad MN, Gorin AB, Yacoub J, Madias NE. Assessing acid-base status in circulatory failure. Differences between arterial and central venous blood. N Engl J Med. 1989;320(20):1312-6. [Crossref]  [PubMed]
  44. Hood VL, Tannen RL. Protection of acid-base balance by pH regulation of acid production. N Engl J Med. 1998;339(12):819-26. [Crossref]  [PubMed]
  45. Orchard CH, Kentish JC. Effects of changes of pH on the contractile function of cardiac muscle. Am J Physiol. 1990;258(6 Pt 1):C967-81. [Crossref]  [PubMed]
  46. Lang RM, Fellner SK, Neumann A, Bushinsky DA, Borow KM. Left ventricular contractility varies directly with blood ionized calcium. Ann Intern Med. 1988;108(4):524-9. Erratum in: Ann Intern Med 1988;109(7):600. [Crossref]  [PubMed]