What kind of disease is lactic acidosis? Lactic acidosis (Hyperlactic acidemia, Lactic acidemia, Lactic acid coma, Lactic acidosis)

Lactic acidosis– 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.

Next, they are 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?

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

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

Lactic acidosis occurs with. 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, as a result - accumulation of lactic acid.

Symptoms

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 pickled apples) is missing.

Then Blood pressure drops sharply (collapse), blood supply to 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.

Causes

The syndrome is provoked by a number of reasons:

Prolonged physical activity provokes muscle hypoxia, which leads to the development of lactic acidosis.

Tumors in the body, such as leukemia, can cause a similar pathological condition of the body. In this case, tumor cells are not capable of breaking down glucose with the help of oxygen and release large amounts of lactate.

In case of infarction of the lungs or intestines, respiratory failure and thiamine deficiency can also provoke a complication in which lactic acidosis develops.

Against the background of atherosclerosis, the vessels stick together, which leads to tissue hypoxia and subsequently to lactic acidosis.

For alcoholism Ethyl alcohol disrupts metabolism, which leads to the accumulation of lactic acid in the body. Pathological condition of the body, may cause methanol poisoning. Moreover, acidosis increases very quickly.

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.

Treatment

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 medication must be carried out under strict control of blood pH, it should 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 throughout the rest of his life must support the body with acetylsalicylic acid and anticoagulants.

Some hypoglycemic drugs are also may cause complications, For example simultaneous use of medications for viral and colds.

Festered wounds can be the initial cause of lactic acidosis.

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

If a diabetic has forgotten to take medication, then you should not compensate for this by taking several tablets at once. Exceeding the dose of medication can provoke serious consequences for 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.

Useful video

In conclusion, we can say that only a healthy lifestyle and giving up bad habits will be a good prevention of all diseases, including reducing the likelihood of an attack of lactic acidosis.

For normal functioning of the body, a balance of all its components is necessary - hormones, blood elements, lymph, enzymes.

Deviations in composition occur as a result of disruption of natural metabolism and lead to dangerous consequences for humans.

Acidosis is a condition in which there is an increased level of acid in the blood.

The natural weakly alkaline environment of the blood changes towards increasing acidity. This does not occur in a healthy body, but as a consequence of various pathological conditions.

What is lactic acidosis?

Lactic acidosis (lactic acidosis) is an increase in the level of lactic acid in the blood. This is caused by its excessive production and impaired excretion from the body by the kidneys and liver. This is a fairly rare condition that is a consequence of certain diseases.

Important: It is one of the complications in elderly patients. Possibility of death is more than 50%.

Lactic acid in the body is a product of glucose processing. Its synthesis does not require oxygen; it is formed during anaerobic metabolism. Most of the acid enters the blood from muscles, bones, and skin.

Subsequently, lactates (lactic acid salts) must pass into the cells of the kidneys and liver. If this process is disrupted, the acid content increases quickly and spasmodically. Excess lactate is formed due to severe metabolic disorders.

Pathology is observed with increased synthesis and disturbances in excretion - kidney disease, disturbances in the content of red blood cells in the blood.

Lactate control is necessary in athletes, since their growth is possible under heavy loads.

There are two types of lactic acidosis:

1. Type A is caused by a lack of oxygen supply to tissues and occurs due to problems with breathing, cardiovascular diseases, anemia, and poisoning.
2. Type B - occurs due to improper formation and removal of acid. Lactic acid is produced in excess and is not utilized in diabetes mellitus and liver pathologies.

Lactic acidosis is generally caused by:

• oncological diseases (lymphomas);
• chronic kidney damage (severe forms of glomerulonephritis, nephritis);
• liver pathologies (hepatitis, cirrhosis);
• genetic diseases;
• poisoning, including those caused by drugs (Phenformin, Methylprednisolone, Terbutaline and others);
• severe infectious diseases;
• toxic alcohol poisoning;
• epileptic seizures.

A normal lactate/pyruvate ratio in the blood (10/1) is of fundamental importance. Violation of this proportion in the direction of increasing lactate increases quickly and can lead to a serious condition for the patient.

Determination of lactate levels is carried out using biochemical analysis. The norms are not defined by international standards, as they depend on the research methods and materials used.

For adults, the normal blood level is in the range of 0.4-2.0 mmol/l.

Features of the development of pathology in diabetes mellitus

One of the main reasons for the development of lactic acidosis is a violation of the oxygen supply to tissues, due to which anaerobic metabolism of glucose develops.

In severe cases of diabetes with additional damage to the kidneys and liver, oxygen transport is significantly reduced, and the organs that are involved in removing lactates from the blood cannot cope with the task.

Factors contributing to the development of the condition:

• liver damage;
• anemia – iron deficiency, folic;
• pregnancy;
• renal pathologies;
• large blood loss;
• stress;
• peripheral arterial disease;
• oncological diseases;
• or other forms of acidosis.

Lactic acidosis is often provoked by taking medications, in particular, a decompensated state of diabetes. Biguanides (Metformin) are treatments for diabetes.

Usually there is a combination of several factors. The severe course of the disease leads to constant tissue hypoxia, and impaired renal function causes intoxication.

Video from Dr. Malysheva about Metformin:

Symptoms and manifestations of a dangerous condition

Symptoms of increased lactate in the blood are fatigue, tiredness, drowsiness, and signs of dyspepsia, nausea and vomiting are also observed. These symptoms are similar to uncontrolled diabetes mellitus.

Excess lactic acid can be indicated by muscle pain, as after hard work. It is on this basis that the development of lactic acidosis is often determined. The pain is myalgic-like and radiates to the chest. All other signs are not specific, and therefore are often interpreted incorrectly.

The started process of lactic acid secretion develops very quickly, the patient’s condition rapidly deteriorates. Several hours pass before hyperlacticidemic coma. During this time, numerous disorders of the body develop - the central and peripheral nervous systems, breathing.

The patient has:

• dyspeptic disorders;
• decreased urine production until it stops;
• hypoxia causes a feeling of lack of air, heavy noisy breathing develops (Kussmaul breathing) with sobs and groans;
• increased blood clotting with the formation of blood clots and possible development of necrosis in the extremities;
• heart rhythm disturbances, deterioration of heart function;
• loss of orientation, stupor;
• dry skin, thirst;
• drop in blood pressure, decrease in body temperature;
• Peripheral nervous system disorders cause seizures and loss of reflexes.

The condition differs from ketoacidosis in the absence of the smell of acetone when exhaling. Cardiac dysfunctions are difficult to correct with medications. Coma may develop within a few hours.

First aid and treatment

Symptoms of lactic acidosis are mostly nonspecific, so the patient should have a quick blood test. Help can only be provided in a hospital setting. It is necessary to differentiate the condition from ketoacidosis and uremic acidosis.

The state of lactic acidosis is indicated by:

1. Lactate level is above 5 mmol/l.
2. Reduced bicarbonate and blood pH.
3. The anion gap in plasma is increased.
4. Increase in residual nitrogen.
5. Hyperlipidemia.
6. No acetonuria.

It is impossible to improve the patient’s condition at home; attempts to help end in death. Urgent hospitalization, timely testing and detection of lactic acidosis and subsequent resuscitation measures can stop the development of coma.

Treatment requires two main actions - eliminating hypoxia and reducing the level of lactic acid and its formation.

Saturation of tissues with oxygen helps stop the uncontrolled formation of lactates. For this, the patient is connected to a ventilator. At the same time, blood pressure is stabilized.

A necessary condition for removing a patient from a serious condition is to identify the causes of lactic acidosis and treat the corresponding diseases.

Hemodialysis is used to remove excess lactic acid.

To normalize the pH of the blood, sodium bicarbonate is injected dropwise. Its introduction is carried out very slowly over several hours.

In this case, the pH value should be below 7.0. This indicator is monitored every 2 hours.

During therapy, Heparin is also used to prevent thrombus formation, drugs from the carboxylase group, and Reopoliglucin.

Insulin is not required; it is usually used in small doses by drip.

Possible complications, prevention

A complication of lactic acidosis is coma. The condition may develop within a few hours. The success of treatment depends on the competence of the personnel, who will identify the danger to the patient in a timely manner. Urgent testing is also required.

With lactic acidosis, the condition worsens quickly - there is a loss of reflexes, a decrease in pressure and temperature to 35°, and respiratory distress. Heart failure can lead to myocardial infarction. Collapse occurs - the patient loses consciousness.

The main way to prevent lactic acidosis is to compensate for diabetes mellitus. Taking medications prescribed by an endocrinologist must be carried out according to the proposed regimen. If you miss a dose, you cannot compensate for the deficiency with an increased dose.

You should not take the advice of your fellow sufferers and use medications that help them without the prescription of a specialist. Patients with diabetes should not use dietary supplements, which are recommended by numerous companies.

It is necessary to keep your sugar within normal limits, regularly visit an endocrinologist and take the required tests. When switching to new drugs, you should monitor your condition without exceeding or reducing the dosage.

It is important to follow the prescribed diet and also lead an active lifestyle. This will help improve metabolism and blood supply to organs. A good way to maintain health is. Modern medicine makes it possible to keep diabetes under control.

Lactic acidosis (lactic acidosis, lactic acidemia, hyperlactic acidemia, lactic acidosis) is a condition in which lactic acid enters the blood much faster than it is removed from it, which can lead to the development of life-threatening complications. In more than 50% of cases, lactic acidosis is recorded in patients with diabetes mellitus.

Against the background of lactic acidosis, cerebral edema and transtentorial herniation, persistent coma, and death can develop.

Lactic acid is the end product of anaerobic glycogenolysis and glycolysis, a substrate of gluconeogenesis, and is used as an energy material by the heart muscle. An increase in the content of lactic acid in the blood is primarily associated with its increased formation in the muscles and a decrease in the liver’s ability to convert lactic acid into glucose and glycogen. In cases of decompensated diabetes mellitus, the level of lactic acid in the blood may also increase as a result of blocking the catabolism of pyruvic acid and an increase in the NAD-H/NAD ratio. The concentration of lactic acid in the blood can act as an additional diagnostic test.

Source: etodiabet.ru

Causes and risk factors

Hypoxia, which occurs in skeletal muscles and is caused by prolonged physical overexertion, can lead to the development of lactic acidosis. 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.

Risk factors include:

• hereditary metabolic disorders;
• taking certain medications (for example, biguanides, especially in the presence of liver and kidney pathologies);
• deficiency of vitamins in the body (especially vitamin B1);
• consumption of methanol or ethylene glycol;
• parenteral administration of fructose in high doses.

In case of lactic acidosis, urgent hospitalization of the patient is required to correct acidosis and hypoxia.

Forms of lactic acidosis

According to the Cohen-Woods clinical classification, lactic acidosis is divided into the following forms:

• type A – acquired;
• type B is hereditary.

Symptoms of lactic acidosis

Lactic acidosis, as a rule, develops acutely, within several hours, and there are usually no warning signs. Patients complain of muscle pain, pain behind the sternum, dyspepsia, apathy, drowsiness or insomnia, rapid breathing. The patient's general condition quickly deteriorates, the increase in acidosis is accompanied by abdominal pain and vomiting, neurological disorders (areflexia, hyperkinesis, paresis).

In severe cases, the prevailing symptoms of lactic acidosis are manifestations of cardiovascular failure, aggravated as the pathological process progresses by severe acidosis. Loss of consciousness and the development of coma are preceded by lethargy, the appearance of noisy breathing in the patient (breathing sounds audible at a distance), and there is no smell of acetone in the exhaled air. The patient develops collapse, first with oligoanuria, and then with anuria, accompanied by disseminated intravascular coagulation (DIC syndrome). In some patients, symptoms of lactic acidosis include hemorrhagic necrosis of the fingers of the upper and lower extremities.

Features of lactic acidosis in children

The hereditary form of lactic acidosis manifests itself in young children as severe acidosis, accompanied by severe respiratory disturbances. Patients experience muscle hypotonia and delayed psychomotor development. Usually, the patient’s condition improves with age, but in some cases the pathological process leads to death.

Approximately 50% of all cases of lactic acidosis occur in patients with diabetes mellitus.

Diagnostics

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 bicarbonate levels 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.

Treatment

In case of lactic acidosis, urgent hospitalization of the patient is required to correct acidosis and hypoxia.

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. Hypoxia is eliminated with oxygen therapy; artificial ventilation may be required. If lactic acidosis develops while taking biguanides, hemodialysis may be necessary.

The hereditary form of lactic acidosis manifests itself in young children as severe acidosis, accompanied by severe respiratory disturbances.

Possible complications and consequences

Against the background of lactic acidosis, cerebral edema and transtentorial herniation, persistent coma, and death can develop.

Forecast

The prognosis for the acquired form of lactic acidosis depends on the underlying disease against which it arose, on the level of lactic acid in the patient’s blood, as well as on the timeliness and adequacy of the treatment. With the development of complications, as well as with the congenital form of lactic acidosis, the prognosis worsens.

Prevention

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.

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Content

Lactic acidosis is a dangerous complication that is caused by the accumulation of lactic acid in skeletal muscles, skin and brain, as well as the development of metabolic acidosis. Lactic acidosis provokes the development of hyperlactic acidemic coma, so this disease is relevant among patients with diabetes mellitus, who should know the causes of the pathological condition.

How does lactic acidosis develop?

An acute complication in which lactate quickly enters the bloodstream is lactic acidosis. Lactic acidosis in type 2 diabetes mellitus can occur after the use of glucose-lowering medications. This adverse reaction is inherent in drugs of the biguanide variety (Metformin, Bagomet, Siofor, Glucophage, Avandamet). The condition is divided into two types:

1. Lactic acidosis type A – tissue hypoxia. The body experiences a lack of oxygen during critical illnesses: sepsis, septic shock, acute stages of liver disease or after severe physical stress.
2. Lactic acidosis type B is not associated with hypoxia of body tissues. Occurs during treatment with certain drugs against diabetes mellitus and HIV infection. This type of lactic acidosis often manifests itself against the background of alcoholism or chronic liver diseases.

Causes

Lactic acidosis is formed due to a malfunction in the body's metabolic processes. The pathological condition occurs when:

• Diabetes mellitus type 2.
• Overdose of Metformin (the drug accumulates in the body due to impaired renal function).
• Oxygen starvation (hypoxia) of muscles after grueling physical activity. This condition of the body is temporary and goes away on its own after rest.
• The presence of tumors in the body (malignant or benign).
• Cardiogenic or hypovolemic shock.
• Thiamine deficiency (Vit B1).
• Blood cancer (leukemia).
• Severe combined injury.
• Sepsis.
• Infectious and inflammatory diseases of various etiologies.
• Presence of alcoholism;
• Heavy bleeding.
• Festering wounds on the body of a diabetic.
• Acute myocardial infarction.
• Respiratory failure.
• Kidney failure.
• Chronic liver diseases.
• Antiretroviral therapy for HIV infection. This group of drugs puts a lot of stress on the body, so it is very difficult to maintain normal levels of lactic acid in the blood.

Signs of lactic acidosis

Lactic acidosis forms at lightning speed, literally in a few hours. The first signs of lactic acidosis include:

• state of apathy;
• pain behind the sternum and in skeletal muscles;
• disorientation in space;
• dry mucous membranes and skin;
• yellowing of the eyes or skin;
• the appearance of rapid breathing;
• the appearance of drowsiness and insomnia.

A severe form of lactic acidosis in a patient is manifested by cardiovascular failure. This disorder provokes changes in myocardial contractility (the number of heart contractions increases). Further, the general condition of the human body worsens, pain in the abdomen, nausea, vomiting, diarrhea, and lack of appetite appear. Then the neurological symptoms of lactic acidosis are added:

• areflexia (one or more reflexes are absent);
• hyperkenesis (pathological involuntary movements of one or a group of muscles);
• paresis (incomplete paralysis).

Before the onset of hyperlactic acidemia coma, symptoms of metabolic acidosis appear: the patient develops deep and noisy breathing (the noise is clearly audible at a distance), with the help of which the body tries to remove excess lactic acid from the body, DIC syndrome (intravascular coagulation) appears. Then symptoms of collapse arise: first, oliguria develops (decreased amount of urine), and then anuria (no urination). Manifestations of hemorrhagic necrosis of the fingers of the extremities are often observed.

Diagnostics

Hyperlactic acidemia is difficult to diagnose only in the presence of subjective symptoms that are not confirmed by test results. Symptoms of lactic acidosis are used as an auxiliary criterion. More Laboratory data based on the measurement of lactic acid are reliable. In addition, determine:

• the amount of bicarbonates (with lactic acidosis they rapidly decrease);
• degree of hyperglycemia;
• lack of acetone in the urine (acetonuria).

Treatment of lactic acidosis

When symptoms of lactic acidosis appear, it is necessary to immediately provide first aid to the human body, which consists of intravenous administration (via a dropper) of 4% or 2.5% sodium bicarbonate solution (up to 2000 ml per day). For treatment, long-acting insulin therapy or monocomponent therapy with “short” insulin is used. In the medical institution, carboxylase drugs are additionally used (intravenous drip - 200 mg per day). In addition, rheopolyglucin solution, blood plasma, and heparin (in small doses) are administered.

Prevention

More often, lactic acid appears in excess quantities in people who did not suspect they had diabetes, so the necessary treatment was not carried out. In the future, to prevent lactic acidosis from reoccurring, you must strictly adhere to the recommendations of specialists on proper nutrition, undergo preventive examinations and tests.

It is imperative to take into account the peculiarities of the effect of glucose-lowering medications on some diabetics. If there are no health problems, then the drugs do not cause complications in the form of lactic acidosis and effectively perform their function. If there are viral or infectious agents in the body, the result after administration of the drug may be unpredictable. For this reason, even if there is the slightest doubt, you should consult a doctor before use.

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Acidosis is a condition of the body characterized by a violation of the acid-base balance of the body with a shift towards increasing acidity and decreasing the pH of its media. The main reason for the development of the condition is the accumulation of oxidation products of organic acids, which are normally quickly eliminated from the body. An increase in the concentration of oxidation products of organic acids during acidosis can be caused by external factors (inhalation of air with a high concentration of carbon dioxide), as well as internal factors that are disruptions in the functioning of systems, as a result of which the metabolism of products and the accumulation of metabolites of organic acids are disrupted. Severe conditions with acidosis provoke shock, coma and death of the patient.

Acidosis of any origin can lead to critical conditions of the body:

• Dehydration;
• Increased blood clotting;
• Critical fluctuations in blood pressure;
• Myocardial infarction, infarction of parenchymal organs;
• Decrease in circulating blood volumes;
• Peripheral thrombosis;
• Impaired brain function;
• Coma;
• Death.

Classification of acidosis

According to the mechanisms of development of acidosis, the following types of disorders are distinguished:

• Respiratory acidosis (inhaling air with a high concentration of carbon dioxide);
• Mixed type of acidosis (a condition caused by different types of acidosis).

Non-respiratory acidosis, in turn, is subject to the following classification:

• Excretory acidosis is a condition that develops when the function of removing acids from the body is impaired (impaired kidney function);
• Metabolic acidosis is the most complex condition characterized by the accumulation of endogenous acids in the tissues of the body;
• Exogenous acidosis is a state of increased acid concentration caused by the intake of a large amount of substances into the body that are converted into acids during metabolism.

According to the pH level, acidosis is classified as:

• Compensated;
• Subcompensated;
• Decompensated.

When the pH level reaches the minimum (7.24) and maximum (7.45) values ​​(normal pH = 7.25 - 7.44), protein denaturation, cell destruction, and enzyme function decrease, which can lead to the death of the body.

Acidosis: causes of the disease

Acidosis is not a disease. This is a condition of the body that is caused by exposure to certain factors. In case of acidosis, the following factors can become the reasons for the development of this condition:

• Fasting, dieting, alcohol abuse, smoking;
• Poisoning, loss of appetite, other disorders of the gastrointestinal tract;
• Conditions of the body in which metabolism is disrupted (diabetes mellitus, circulatory failure, febrile conditions);
• Pregnancy;
• Malignant neoplasms;
• Dehydration of the body;
• Kidney failure;
• Poisoning with substances whose metabolism in the body leads to the formation of excess acids;
• Hypoglycemia (low blood glucose levels);
• Oxygen starvation (in states of shock, anemia, heart failure);
• Renal bicarbonate loss;
• The use of a certain number of drugs (salicylates, calcium chloride, etc.);
• Respiratory failure.

In some cases, with acidosis, there are no reasons that clearly indicate the development of the condition.

Acidosis: symptoms, clinical picture of the disease

With acidosis symptoms are difficult to differentiate from symptoms of other diseases. In mild forms of acidosis, symptoms are not associated with a shift in the body’s acid-base balance. The main symptoms of acidosis are:

• Short-term nausea, vomiting;
• General malaise;
• Increased heart rate, shortness of breath;
• Cardiac arrhythmias;
• Increased blood pressure;
• Disorder of the functions of the central nervous system (drowsiness, confusion, dizziness, loss of consciousness, lethargy);
• Shock conditions;

It should be noted that in mild forms of acidosis, symptoms may not appear at all.

Diagnosis of acidosis

To accurately diagnose acidosis, the following research methods are used:

• Analysis of blood gas composition (for analysis, arterial blood is taken from the radial artery at the wrist; analysis of venous blood will not accurately determine the pH level);
• Urine pH level analysis;
• Arterial blood analysis for serum electrolytes.

Blood tests for basic metabolic parameters (gas composition and level of serum electrolytes) show not only the presence of acidosis, but also determine the type of acidosis (respiratory, metabolic). Other tests may be needed to determine the cause of acidosis.

Acidosis: treatment

Based on the fact that this condition is caused by disturbances in the functioning of the body's systems, in case of acidosis, treatment is reduced to the treatment of the underlying disease, pathological condition or dysfunction that provoked a shift in the acid-base balance of the body.

To correct metabolic acidosis, treatment involves intravenous fluids as well as treatment of the underlying disease causing the condition.

In severe forms of acidosis, treatment involves prescribing medications containing sodium bicarbonate (drinking, infusion solutions) to increase the pH level to 7.2 or higher. Sodium bicarbonate is added to solutions of glucose or sodium chloride, depending on disturbances in circulating blood volumes due to acidosis.

To relieve pronounced ailments due to acidosis, symptomatic treatment is prescribed. When acidosis develops due to poisoning, treatment involves removing the toxic substance from the body; in cases of severe poisoning, dialysis is used.

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What is Acidosis

Acidosis(from Latin acidus - sour), a change in the acid-base balance of the body as a result of insufficient excretion and oxidation of organic acids (for example, betahydroxybutyric acid). Typically, these products are quickly eliminated from the body. In case of febrile diseases, intestinal disorders, pregnancy, fasting, etc., they are retained in the body, which is manifested in mild cases by the appearance of acetoacetic acid and acetone in the urine (the so-called acetonuria), and in severe cases (for example, with diabetes) can lead to to a coma.

What causes acidosis

Typically, the oxidation products of organic acids are quickly removed from the body. In case of febrile diseases, intestinal disorders, pregnancy, fasting, etc., they are retained in the body, which is manifested in mild cases by the appearance of acetoacetic acid and acetone in the urine (the so-called. acetonuria), and in severe cases (for example, with diabetes) it can lead to coma.

Pathogenesis (what happens?) during Acidosis

According to the mechanisms of occurrence, there are 4 types of acid-base disorders, each of which can be compensated or decompensated:

1. non-respiratory (metabolic) acidosis;
2. non-respiratory (metabolic) alkalosis;
3. respiratory alkalosis.

Non-respiratory (metabolic) acidosis- This is the most common and most severe form of acid-base imbalance. Non-respiratory (metabolic) acidosis is based on the accumulation in the blood of so-called non-volatile acids (lactic acid, hydroxybutyric acid, acetoacetic acid, etc.) or the loss of buffer bases by the body.

Symptoms of Acidosis

The main symptoms of acidosis are often masked by the manifestations of the underlying disease or are difficult to distinguish from them.

Diagnosis of Acidosis

In severe acidosis, when the content of bicarbonate ions in the plasma becomes very low, the urine pH drops below 5.5, the blood pH below 7.35, and the HCO3 concentration below 21 mEq/L. In the absence of pulmonary diseases, the partial pressure of carbon dioxide in arterial blood does not reach 40 mmHg. Art. With simple metabolic acidosis, it can decrease by about 1-1.3 mm Hg. Art. for every mEq/L decrease in plasma HCO3 levels. A greater drop in paCO2 indicates simultaneous primary respiratory alkalosis.

Many forms of metabolic acidosis are characterized by increase in undetectable anions. The amount of serum undetectable anions (sometimes called anion gap or anion deficiency) is estimated by the difference between the serum sodium concentration and the sum of the chloride and bicarbonate concentrations.

Metabolic acidosis may be associated with the accumulation of undetectable anions - for example, sulfate in renal failure, ketone bodies in diabetic or alcoholic ketoacidosis, lactate or exogenous toxic substances (ethylene glycol, salicylates). Metabolic acidosis with normal amounts of undetectable anions (hyperchloremic metabolic acidosis) is usually due to primary loss of bicarbonate through the gastrointestinal tract or kidneys (eg, renal tubular acidosis).

Diabetic acidosis usually characterized by hyperglycemia and ketonemia. With hyperglycemia and non-ketone (according to routine clinical tests) acidosis, the content of lactic and/or p-hydroxybutyric acid in the blood is increased.

Ethylene glycol poisoning should be suspected in unexplained acidosis if oxalate crystals are present in the urine.

Salicylate poisoning characterized first by respiratory alkalosis and then by metabolic acidosis; the level of salicylates in the blood usually exceeds 30-40 mg%.

Since acidosis is often accompanied by hypovolemia, mild azotemia is often observed (blood urea nitrogen content 30-60 mg%). Greater increases in blood urea nitrogen, especially when combined with hypocalcemia and hyperphosphatemia, suggest renal failure as the cause of acidosis. Hypocalcemia is sometimes observed in septic shock. Changes in serum potassium levels during acidosis are discussed above (see disorders of potassium metabolism). In lactic acidosis, hyperkalemia is relatively rare unless there is concurrent renal failure and/or increased tissue breakdown.

Treatment of Acidosis

Elimination of the cause that caused acidosis (for example, lack of insulin in diabetes), as well as symptomatic - ingestion of soda, drinking plenty of fluids.

Which doctors should you contact if you have Acidosis?

Therapist

Reanimatologist

Emergency doctor

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Causes of lactic acidosis

Most often, lactic acidosis develops in type 2 diabetes mellitus in patients who have suffered a myocardial infarction or stroke as a result of the underlying disease.

The main reasons that contribute to the development of lactic acidosis in the body are the following:

• oxygen starvation of tissues and organs of the body;
• development of anemia;
• bleeding leading to large blood loss;
• serious liver damage;
• the presence of renal failure developing while taking metformin, if the first symptom from the specified list is present;
• high and excessive physical stress on the body;
• the occurrence of shock or sepsis;
• cardiac arrest;
• the presence of uncontrolled diabetes mellitus in the body, even if a diabetic antihyperglycemic drug is taken;
• the presence of some diabetic complications in the body.

The occurrence of pathology can be diagnosed in healthy people due to the impact of certain conditions on the human body and in patients with diabetes.

Most often, lactic acidosis develops in diabetics against the background of uncontrolled diabetes mellitus.

For a diabetic, this state of the body is extremely undesirable and dangerous, since in this situation a lactic acidotic coma can develop.

Lactic acid coma can be fatal.

Symptoms and signs of complications

Symptoms and signs of lactic acidosis in diabetes may include the following:

• disturbance of consciousness;
• feeling of dizziness;
• loss of consciousness;
• the appearance of a feeling of nausea;
• the appearance of the urge to vomit and vomiting itself;
• frequent and deep breathing;
• the appearance of pain in the abdomen;
• the appearance of severe weakness throughout the body;
• decreased physical activity;
• development of deep lactic acid coma.

If a person has the second type of diabetes mellitus, then falling into a lactic coma is observed some time after the first signs of the development of complications appear.

When a patient falls into a comatose state, he experiences:

1. hyperventilation;
2. increased glycemia;
3. decrease in the amount of bicarbonates in the blood plasma and decrease in blood pH;
4. a small amount of ketones is detected in urine;
5. the level of lactic acid in the patient’s body rises to 6.0 mmol/l.

The development of the complication is quite acute and the condition of a person with type 2 diabetes mellitus worsens gradually over several hours in a row.

The symptoms accompanying the development of this complication are similar to the symptoms of other complications, and a patient with diabetes mellitus is able to fall into a coma with both low and high levels of sugar in the body.

All diagnosis of lactic acidosis is based on a laboratory blood test.

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What is lactic acidosis?

Although this is a rare, but very dangerous syndrome (or complication), which occurs when there is an increased accumulation of lactic acid (LA) in the blood, and acidosis is accompanied by a large anion gap.

Normally, a small amount of UA is produced daily, generated through metabolism. It is almost immediately utilized to form lactate. This substance is converted in the liver through oxidation into several compounds or substances such as CO2 (carbon dioxide) and water or (depending on needs) into glucose with the regeneration of HCO3- (bicarbonate).

If a large amount of lactic acid accumulates, then, accordingly, lactate output is disrupted. This leads to lactic acidosis.

Causes

Typically, lactic acidosis occurs in seriously ill people who not only suffer from type 2 diabetes mellitus, but have also suffered a myocardial infarction or stroke.

Main features:

• tissue hypoxia (in other words, lack of oxygen or oxygen starvation)
• anemia (anemia)
• excessive blood loss due to hemorrhage
• serious liver damage
• indirectly - renal failure while taking metformin in the presence of the first sign from the list
• shock or sepsis
• heart failure
• carbon monoxide poisoning
• severe form of acidosis
• uncontrolled diabetes mellitus in the osprey with the use of hypoglycemic drugs and some existing diabetic complications

Symptoms and signs

To characterize the patient’s condition in the presence of this syndrome, it is worth understanding that this is a rare complication and is more often characteristic of people with numerous health problems (usually older people with advanced diabetes with existing liver failure).

It is quite acute and the patient’s condition worsens within a few hours.

Typically a person feels and experiences the following sensations:

• disturbance of consciousness
• mental confusion
• dizziness
• loss of consciousness
• nausea
• vomit
• frequent deep breathing
• abdominal pain
• severe weakness throughout the body
• there is a weakening of motor activity
• deep lactic acid coma (a person falls into a coma only after some time in the presence of the above-described symptoms)

This creates:

• hyperventilation
• moderately elevated glycemia (typical of diabetes and rarely exceeds critical levels)
• decrease in blood plasma bicarbonates and pH (CO2 level in the blood drops)
• the presence of ketones in the blood is negative, and there is an insignificant amount of them in the urine (only under conditions of prolonged fasting)
• hyperphosphatemia (if azotemia test is negative)
• lactic acid level exceeds 6.0 mmol/l - absolute diagnostic criterion

If you look at the symptoms described above, most of these symptoms can be attributed to other diseases or complications, which, as a rule, develop rapidly. A diabetic can fall into a coma either with low blood sugar or with high blood sugar, and the symptoms will be similar. Therefore, the entire diagnosis of lactic acidosis is based primarily on a blood test! If a sample is not taken, such a decision may cause the death of the patient.

Treatment of lactic acidosis in diabetes mellitus

Since this condition can be provoked primarily by a lack of oxygen, the treatment of lactic acidosis is based on the scheme of saturating the cells and tissues of the body with oxygen through mechanical ventilation.

Of course, the patient’s blood pressure must be monitored and all his vital signs monitored. Particularly careful monitoring is carried out for older people suffering from arterial hypertension, liver complications or any other serious health problems.

Before a diagnosis of lactic acidosis is made, blood tests will be taken from the patient to determine the pH level and potassium concentration.

In severe cases, sodium bicarbonate is prescribed, but only if the blood pH is<7.0. Без результатов pH раствор вводить нельзя!

The solution commonly used is: 50 mmol of bicarbonate is dissolved in 200 ml of sterile water with 10 mEq of potassium chloride. Introduce gradually over 2 hours. An analogue of the solution can be 4 g of bicarbonate in the form of 200 ml of a 2% solution, administered intravenously also slowly and over one hour.

If the pH< 6.9, то в таком случае применяют 100 ммоль бикарбоната, который разводят в 400 мл стерильной воды с 20 мЭкв хлорида калия со скоростью 200 мл/час в течение двух часов (или 8 гр. бикарбоната в виде 400 мл 2%-ного раствора в течение двух часов).

The pH of the venous blood is assessed every 2 hours and bicarbonate is continued until the pH level exceeds 7.0.

If the patient also has acute renal failure, then renal hemodialysis is used. Peritoneal dialysis may also be performed to restore normal blood bicarbonate levels.

Of course, in diabetes, adequate insulin therapy is used to correct carbohydrate metabolism. Heparin and rheopolyglucin can be used in small doses.

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Where does excess lactate come from?

Under the influence of biochemical catalysts, the glucose molecule breaks down and forms two molecules of pyruvic acid (pyruvate). With sufficient oxygen, pyruvate becomes the starting material for most of the cell's key metabolic processes. In case of oxygen starvation, it turns into lactate. A small amount of it is needed by the body; lactate returns to the liver and is converted back into glucose. This forms a strategic reserve of glycogen.

Normally, the ratio of pyruvate to lactate is 10:1; under the influence of external factors, the balance can shift. A life-threatening condition occurs - lactic acidosis.

A critical increase in the level of lactic acid in the body is a condition that requires emergency, immediate hospitalization. Up to 50% of detected cases lead to death!

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Causes of diabetic lactic acidosis

Hyperglycemia causes excess sugar in the blood to be rapidly converted into lactic acid. Lack of insulin affects the conversion of pyruvate - the absence of a natural catalyst leads to an increase in lactate synthesis. Persistent decompensation contributes to chronic cell hypoxia and entails a lot of complications (kidneys, liver, cardiovascular system), which aggravate oxygen starvation.

A large proportion of manifestations of lactic acidosis occur in individuals taking glucose-lowering drugs. Modern biguanides (metformin) do not cause persistent accumulation of lactic acid in the body, however, when several provoking factors occur (infectious disease, injury, poisoning, alcohol intake, excessive physical activity) they can contribute to the pathological condition.

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Symptoms of lactic acidosis in diabetes mellitus

Drowsiness, weakness, fatigue, heaviness in the limbs are observed, nausea and, less commonly, vomiting may occur. Lactic acidosis is dangerous because it develops rapidly in just a few hours. After general diabetic symptoms, diarrhea, vomiting and confusion develop rapidly. At the same time, there are no ketone bodies in the urine, and there is no smell of acetone.

If visual ketoacidosis and glucose test strips show only high sugars and muscle pain is observed, you should immediately call an ambulance! If you do not take any action and try to stop the condition on your own, then a sharp decrease in blood pressure, rare and noisy breathing, and heart rhythm disturbances will result in coma.

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Treatment of hyperlactic acidemia

It is almost impossible to provide first aid for signs of lactic acidosis. It is not possible to reduce blood acidity outside the hospital. Alkaline mineral water and soda solutions will not lead to the desired result. In case of low blood pressure or shock, the use of dopamine is justified. It is necessary to ensure maximum air flow; in the absence of an oxygen pillow or inhaler, you can turn on the humidifier and open all the windows.

The prognosis for recovery from lactic acidosis is unfavorable. Even adequate treatment and timely consultation with doctors do not guarantee life saving. Therefore, diabetics, especially those taking metformin, should listen carefully to their body and keep their sugar levels in the target range.

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Causes of acid-base imbalance

Most often, acids accumulate due to metabolic disorders. For example, with renal failure, diabetes mellitus or thyrotoxicosis. This can also happen due to poor nutrition, when the food contains insufficient carbohydrates and excess fat, during fasting or prolonged use of low-carbohydrate diets, as well as after taking certain medications, for example, salicylates and drugs containing ammonium chloride. The lack of alkalis to neutralize acids occurs due to the loss of sodium biocarbonate by the body during vomiting, diarrhea and other digestive disorders.

Less common is the so-called respiratory acidosis, which occurs due to circulatory failure and dysfunction of the respiratory system. This leads to the accumulation of carbon dioxide in the blood. The reason for this may also be a person’s prolonged stay in a closed room without ventilation.

Symptoms that can help identify acidosis

Even mothers of small children need to know what this is, because this condition is especially difficult for them. Lack of acid neutralization leads to headaches, lethargy, sleep disturbances and low blood pressure. Constipation is common or diarrhea, loss of appetite and vomiting. With acidosis, there is increased breathing, a sour or chemical odor from the mouth and skin. The accumulation of acids in tissues can lead to gastritis and ulcers, intestinal inflammation and cystitis. The production of acidic sweat causes eczema and other skin diseases, such as cellulite. Arthritis or gout develops due to the accumulation of salts in the joints. Severe cases can lead to central nervous system depression and coma.

How to prevent acidosis?

What this is, everyone, even a healthy person, needs to know. Indeed, very often women’s passion for dieting and fasting leads to acidosis. And in children it can appear due to poor nutrition, for example, a passion for baking, fast food and a lack of fresh vegetables and fruits in the diet.

Acidosis can also appear due to prolonged physical exertion or oxygen deprivation. Therefore, in order for a healthy person to prevent this condition, you need to monitor your diet, walk more in the fresh air and give up bad habits. The diet should be dominated by raw plant foods. You need to give up sausages, animal fats, confectionery and canned foods. It is necessary to drink as much fresh water as possible. And to quickly relieve the symptoms of acid poisoning, you can drink a soda solution.

A very dangerous condition that can lead to death is acidosis. What is this you need to know in order to avoid severe damage to organs and tissues.

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Metabolic acidosis

The most common type of acidosis is metabolic. With this type, a lot of acid is produced, which is excreted in very small quantities.

Metabolic acidosis is divided into types:

• Diabetic ketoacidosis, in which there is an excess of ketone bodies in the body.
• Hyperchloremic acidosis occurs when bicarbonate is lost, for example, after diarrhea.
• Lactic acidosis is the accumulation of lactic acid due to alcohol abuse, heavy physical activity, malignant tumors, hypoglycemia, the use of certain medications, anemia, convulsions, etc.

Metabolic acidosis manifests itself in the following symptoms:

1. Stunned, stuporous or lethargic state.
2. Rapid breathing.
3. Shock and, as a result, death.

This type of disease is diagnosed by a blood test for acid-base balance. Treatment is aimed at eliminating the underlying cause. Sodium bicarbonate or sodium bicarbonate solution is injected intravenously. To prevent death from metabolic acidosis, it should be treated.

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Lactic acidosis

Lactic acidosis is another common condition in which there is a significant buildup of lactic acid. Type A is marked by obvious tissue anoxia. Type B practically does not manifest itself.

Type A appears more often. Type B manifests itself very quickly, the reasons for which scientists have not yet reliably identified.

Type A lactic acidosis develops due to:

1. Diabetes.
2. Epilepsy.
3. Convulsive conditions.
4. Hodgkin's disease.
5. Liver and kidney diseases.
6. Neoplasia.
7. Myelomas.
8. Infections.
9. Leukemia.
10. Bacteremia.
11. Generalized lymphoma.

Type B lactic acidosis develops due to exposure to pesticides, toxins and drugs.

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Causes of acidosis

Maintaining a normal acid-base balance is as important a factor as the absence of any infectious diseases. The main causes of acidosis are lifestyle, sedentary daily routine and poor diet. The environment in which a person lives also affects.

Nutrition plays a very important role. Only acidic foods seem to promote acidosis. In fact, acid in the body is the result of the breakdown and oxidation of food elements. It is important that the kidneys and lungs work well. The kidneys help in eliminating non-volatile elements, and the lungs help in eliminating volatile elements.

In addition, the body should not have metabolic disorders, and there should be no chronic diseases that provoke latent acidosis. These include tumors, allergic reactions, neuroses, rheumatism, tissue inflammation, etc.

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Symptoms of acidosis

Acidosis often manifests itself in the same symptoms as the underlying disease. In a mild form, it may not appear at all. Sometimes it causes nausea, vomiting and fatigue. The severe form manifests itself in disturbances in the frequency and depth of breathing, heart contractions and stupor. The severe form is also marked by metabolic disorders in the brain. This leads to constant drowsiness and coma.

The acute form of acidosis is recognized by the appearance of diarrhea and insufficient blood supply to tissues. Reduced blood flow provokes dehydration, shock, acute blood loss and heart disease.

In children, acidosis may occur due to the congenital nature of the disease. This affects its development, leading to convulsions and lethargy.

The initial stage can be recognized by:

• Weaknesses.
• Headache.
• Drowsiness.
• Lethargy.
• Depression of the nervous system.

Worsening acidosis is accompanied by the appearance of:

Diabetes mellitus causes a fruity smell in the mouth, among other symptoms.

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Acidosis and alkalosis

Acidosis and alkalosis are abnormalities in metabolic processes in the body. Acidosis is an increase in acid levels. Alkalosis is a deviation towards alkalis.

In the compensated form of the disease, a change occurs in sodium bicarbonate and carbonic acid. In the decompensated form, there is a violation of the amount of acids and alkalis in the direction of an excess of one of the substances.

Quite often, acidosis occurs due to non-respiratory causes. This is the accumulation of lactic acid, acetoacetic or hydroxybutyric acid. The accumulation of lactic acid is often noted due to problems with the heart or lungs (oxygen starvation). The disease also develops against the background of diarrhea. In this case, the body includes compensatory functions when a balance occurs between acids and alkalis.

Alkalosis and acidosis affect the functioning of the body. Breathing changes, vascular tone decreases, cardiac output and blood pressure decrease. Water and electrolyte balance is disturbed. The bones lose their hardness, and changes in the functioning of the heart gradually occur.

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Treatment of acidosis

Since acidosis practically does not manifest itself, treatment is aimed at eliminating the causes of its occurrence. However, the phenomenon itself is not ignored. Acidosis is treated with protein foods in mild forms. Medicines include sodium bicarbonate orally for mild cases or intravenously for severe cases. Calcium carbonate is prescribed if it is necessary to limit the amount of sodium and for hypocalcemia.

Metabolic acidosis is treated:

1. Sodium bicarbonate.
2. Nicotinic acid.
3. Cocarboxylase.
4. Riboflavin mononucleotide.
5. Glutamic acid.
6. Dichloroacetate.

For pathologies in the gastrointestinal tract, Rehydration salt and Dimephosphone are taken orally.

The main emphasis is on proper nutrition. During treatment you should avoid coffee and alcoholic beverages. Fruits, vegetable fats, berries, fresh vegetables are taken along with white bread, pasta, and animal fats. It is actively recommended to take a decoction of rice to remove toxins, waste and other harmful elements.

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Forecast

Acidosis affects the functionality of the entire body. If the acid-base balance is disturbed, then other systems are disturbed. The heart, lungs and kidneys are mainly affected. However, acidosis often indicates the development of other diseases that affect metabolic disorders. The prognosis depends entirely on therapeutic measures to eliminate the cause and the acidosis itself.