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[Lactate metabolism and lactic acidosis]
K Kawanishi1, S Tada, T Kajikawa
1Department of Clinical Laboratory, Kagawa Medical University.
Rinsho Byori. the Japanese Journal of Clinical Pathology
|October 7, 1998
Summary
Lactic acidosis, often linked to malignancy and organ failure, presents serious health risks. Prompt diagnosis and treatment are crucial for improving patient outcomes in these critical conditions.
Area of Science:
- Biochemistry
- Pathophysiology
- Clinical Medicine
Background:
- Lactate metabolism is primarily linked to pyruvate, with production influenced by pyruvate concentration and redox state.
- Hyperlactatemia, or elevated blood lactate, is a marker for various pathological conditions, including tissue hypoxia, alkalosis, and catecholamine surges.
- Current diagnostic criteria for lactic acidosis involve pH < 7.35 and lactate levels > 5-6 mmol/l.
Discussion:
- Malignancy was the most frequent underlying condition associated with lactic acidosis in the study series.
- Organ failure, cardiovascular disease, and diabetes mellitus were commonly observed comorbidities, often associated with a grave prognosis.
- Complications of lactic acidosis in diabetes mellitus included alcoholic liver disease, rhabdomyolysis, and diabetic comas, with alcohol abuse being a frequent precipitant.
Key Insights:
- Patients with lactic acidosis, particularly those with underlying malignancy or organ failure, face a high mortality risk.
- In diabetic patients with lactic acidosis, prominent hyperlactatemia, hyperglycemia, acidemia, and elevated anion gap were noted, with a 36% mortality rate, increasing with organ failure.
- Alcohol abuse is a significant factor in lactic acidosis associated with diabetes mellitus.
Outlook:
- Treatment strategies for lactic acidosis encompass alkalization (sodium bicarbonate, carbicarb), insulin-glucose infusions, dichloroacetate therapy, and various dialysis methods.
- Further research into the complex interplay between metabolic derangements and organ-specific pathology in lactic acidosis is warranted.
- Understanding the specific etiologies and complications of lactic acidosis is crucial for developing targeted therapeutic interventions and improving patient survival rates.