Lactic acidosis – this is a syndrome specific to diabetes mellitus, but it can develop in some other serious pathological conditions, which are characterized by an increase in the synthesis and accumulation of lactic acid in the blood and tissues.
Lactic acidosis is also called lactic acid coma or lactic acid coma. This type of coma can develop in conditions that are accompanied by anorexia and shock: these are cardiogenic shock, severe pathologies of the liver and kidneys, carbon monoxide poisoning, leukemia, anemia, pheochromocytoma, enzymatic disorders.
How does lactic acidosis manifest itself? What treatment does this condition require?
The main causes and mechanism of development of lactic acidosis
Previously, lactic acidosis has been observed with long-term treatment with phenformin biguanide. When treated with metformin, this complication is extremely rare.
Lactic acidosis develops against the background of hypoxia and stimulation of anaerobic glycolysis. In this case, an increase in the lactate / pyruvate ratio occurs, which is normally 10/1. Lack of insulin inhibits the enzyme pyruvate dehydrogenase, which catalyzes the conversion of pyruvic acid to end products.
This process is accompanied by increased conversion of pyruvate to lactate. Hypoxia and other aforementioned etiological factors slow down the resynthesis of lactate into glycogen, as well as the conversion of lactic acid into pyruvic acid.
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Contributing factors for the development of lactic acidosis may be:
- sepsis;
- physical activity;
- intoxication, biguanide poisoning;
- blood loss;
- acute infection.
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Clinical picture in the development of lactic acidosis
Lactic acidosis is a rare but very dangerous condition, after which the largest number of deaths is recorded. The mortality rate is 80%.
In the clinical picture, rapidly progressing cardiovascular insufficiency, leading to the development of arterial hypotension, collapse, cerebral hypoxia, comes to the fore. Against this background, a violation of consciousness develops.
Lactic acidosis is characterized by hyperventilation, accelerated breathing, which can turn into Kussmaul breathing.
Because the clinical manifestations of lactic acidosis are nonspecific, the diagnosis of lactic acidosis coma should be suspected in a diabetic patient who has developed hypotension. A shock state in which the severity of acidosis does not correspond to the degree of ketosis should also be regarded as lactic acidosis.
Thus, in most cases, the diagnosis of lactic acidosis – this is a diagnosis of exclusion.
Important aspects of the diagnosis and treatment of lactic acidosis
The final diagnosis is established in the presence of an elevated plasma lactic acid level of more than 5 mmol / l, as well as a decrease in arterial blood pH below 7.2. Glycemic levels slightly elevated or normal.
1. Treatment of lactic acidosis is carried out by intravenous infusion of 1-2 liters per day of 2.5% sodium bicarbonate solution. For extreme acidosis, 8.5% sodium bicarbonate solution is used.
2. Rapid and effective elimination of acidosis is possible with the use of 50-100 ml of a 1% solution of methylene blue when administered intravenously, as well as with the use of trisamine.
3. Insulin therapy is given in low doses along with 5% glucose solution.
4. An additional method in the fight against shock is the infusion of plasma substitutes. Dynamic control of blood parameters is required, such as the concentration of ketone bodies and lactates, pH, pCO2, pO2. Rapid detection and treatment of lactic acidosis can prevent death.
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