Disease lactic acidosis. Lactic acidosis: causes, symptoms and treatment of lactic acidosis. The symptoms of lactic acidosis are common to many health problems. If you experience any of these symptoms, contact your doctor immediately. Your doctor can help

Lactic acidosis is not a sentence! A complication caused by diabetes mellitus, if detected in the early stages, it is possible to stop and return a person to his full life.

Lactic acidosis is a kind of pathology caused by a number of formidable complications, occurring most often against the background of diabetic conditions and diseases of the cardiovascular system, as well as kidney and liver failure.

What is lactic acidosis? This disease can be deciphered as "lactate" - lactic acid and "acidosis" - a process when acidity rises.

This severe disease manifests itself under certain conditions in excessive production and accumulation of lactic acid in the hematopoietic system and tissues of the human body.

A complication in the form of lactic acidosis rarely develops on its own, it usually occurs with diabetes and in conjunction with the symptoms of diabetic coma, which leads to the death of the patient in up to 90%.

Causes of the disease

Why does lactic acidosis develop? Lactic acid begins to accumulate in the muscle structure, skin, human brain. In particular, its growth becomes noticeable due to the irregularity of the physical workload of a person. This is manifested by some soreness and discomfort in the muscles. And if metabolic processes fail, lactate is released in large quantities into the hematopoietic system, which leads to the onset of the development of the described disease. This complication can develop not only in diseases of a diabetic nature, but also in the following conditions:

In infectious diseases of various etiologies, as well as due to inflammatory processes in the body;
With alcohol dependence;
Due to extensive bleeding;
Along with possible injuries;
With a heart attack;
Insufficiency of the liver and kidneys.

Lactic acidosis in diabetes mellitus is manifested as a result of the consumption of drugs aimed at lowering human blood sugar. The causes of this complication can be tumors, blood cancer, acquired immune deficiency syndrome, lack of a vitamin complex, and respiratory failure.

Symptoms

The described disease has a rapid progression, up to several hours, occurring without any symptoms. But a certain suspicion can lead to an excessive amount of acid in the hematopoietic system:

Soreness in muscle tissue;
Pain in the chest area;
apathetic states;
Sleepiness or insomnia;
Frequent breathing.

But the most basic symptom and dangerous in lactic acidosis is cardiovascular insufficiency, it is the latter that can be complicated by an increase in acidity. And then there is respiratory paralysis and death of the patient.

Our readers write

Topic: Defeated diabetes

From: Galina S. ( [email protected])

To: site administration

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Developing, the disease manifests itself in the form of nausea, vomiting, and unbearable pain in the abdomen.

These symptoms of the described disease are very similar to the decompensation of diabetes mellitus. And if resuscitation measures are not taken with such symptoms, the state of health will become more complicated.

The patient will not be able to adequately respond to reality or will do it in slow motion. Muscles can involuntarily contract, convulsive syndrome and a weakening of motor function may appear.

And as a result, before the development of hyperlactacidemic coma, breathing will become intermittent, and the patient will lose consciousness.

As a result of the foregoing, it is necessary to take timely measures and prevent such conditions.

How to treat

If a person has the above symptoms, you should immediately seek medical help. Of course, it is not necessary that lactic acidosis will be detected, but such symptoms are also not the norm, which means that some additional examination will be required to clarify the diagnosis.

An important factor in establishing the correct diagnosis is a blood test. And if its result shows the presence of a high amount of lactic acid and a low indicator of the alkaline component and bicarbonates, then this is lactic acidosis. And you need to start immediately eliminating the causes by which it was caused.

First you need to drip the patient by injecting him with a solution of sodium bicarbonate. Such therapy must necessarily be carried out along with controlling potassium in the hematopoietic system and normalizing pH.

Patients with diabetic diseases must be prescribed in the form of insulin therapy, and if necessary, adjust the daily dosage or change the agent used.

Also, to cure the patient from the described disease, carboxylase is prescribed intravenously or by drip. Blood plasma and small doses of heparin can be administered as directed.

What is used for the treatment of lactic acid coma:

To compensate for it, the antiseptic substance methylene blue is instilled, which binds hydrogen ions;
To eliminate lactic acidosis, trisamine is used, the best remedy for cardiovascular diseases;
Introduction to dialysis.

Resuscitation care is intravenous administration of sodium bicarbonate, which can reach up to two liters per day in volume.

It must be remembered that if you try to cope with such a complication on your own, then a rapid decrease in blood pressure will be followed by respiratory disorders, cardiac motility. The patient will fall into a lactic acid coma, and possibly death will occur.

It's important to know!

Most often, the described disease lactic acidosis, in the absence of any symptoms, is detected in patients who either did not suspect the presence of diabetes mellitus at all, or its therapy proceeded without control and drug treatment.

Therefore, in order to avoid such a dangerous complication as lactic acidosis, it is necessary to consult a doctor in a timely manner and follow all his recommendations, as well as constant monitoring, examinations and tests.

Any alarming symptomatology for a patient with diabetes mellitus should result in a visit to the doctor!

Video

Lactic acidosis is a dangerous complication, although it occurs extremely rarely. This pathology is manifested in the accumulation of lactic acid in the blood, the indicators of which are many times higher than the norm.
In medicine, this disease is also called lactic acidosis. The development of this complication in type 2 diabetes is dangerous because the patient may fall into a hyperlactacidemic coma.

General information about lactic acidosis

This pathology is diagnosed if lactic acid in the body of a diabetic exceeds 4 mmol / l. The normal coefficient varies from 1.5 to 2.2 mEq / l in venous blood and from 0.5 to 1.6 in arterial. In healthy people, lactic acid is produced in minimal amounts, converting to lactate during the breakdown process.

The liver is responsible for the accumulation of lactic acid in the body. In this organ, the substance not only accumulates, but also breaks down into molecules of glucose, water and carbon monoxide. If lactate accumulates in large quantities, there is a violation of the scheme of its output, which is fraught with the development of lactic acidosis and a sharp shift in acidity.

If lactic acid rises in a healthy person, then it can provoke the onset of diabetes, since such disorders make insulin inactive. Insulin resistance leads to the production of secretory elements that cause a violation of fat metabolism. The result is dehydration, intoxication and acidosis. If the patient is not provided timely assistance, he will fall into a hyperglycemic coma. It is also worth considering that against the background of general intoxication, protein metabolism disorders appear, due to which the quantitative characteristics of metabolites increase and the patient begins to complain about the symptoms presented:

weakness;
depression of the central nervous system;
breathing problems;
vascular insufficiency.

With untimely relief of this symptomatology, a fatal outcome occurs.

What provokes the development of lactic acidosis?

Lactic acidosis in type 2 diabetes develops under the influence of factors that are presented:

Violation of metabolic processes.
Anemia of various types.
High levels of fructose in the blood fluid.
Bleeding.
Alcohol poisoning.
Mechanical damage to organs and skin.
An increase in lactate levels due to taking sugar-lowering drugs.
Hypoxia accompanying ailments of the respiratory and cardiovascular systems.
An increase in lactic acid as a result of hepatic pathologies.
Vitamin B1 deficiencies.
Diabetic ketoacidosis.

In addition to diabetes, lactic acidosis can develop after strokes and heart attacks.

Symptoms of the disease

The disease occurs suddenly and develops in just a few hours. If medical care is not provided to the diabetic at this stage, the changes will be irreversible. The only symptom that indicates the development of this particular pathology is represented by muscle pain without prior physical exertion. Other signs of the disease in diabetes are easily confused with the symptoms of other diseases.
Symptoms of lactic acidosis are:

dizziness and possible loss or disturbance of consciousness;
shortness of breath;
slowing down urination;
nausea and urge to vomit;
migraine;
weakening of motor skills;
allergies in the abdominal area;
problems with coordination.

An increase in lactic acid levels leads to the rapid development of the following symptoms, presented:

noisy breathing;
malfunctions in the work of the heart;
increased excitability and distraction;
decrease in blood pressure;
violation of blood coagulation, leading to the development of thrombosis;
convulsive syndrome.

The appearance of secondary symptoms, as a rule, ends in coma. The patient ceases to see, hear, temperature indicators fall to 35 0 C, the face sharpens, urination stops and the patient falls into a coma.

It should be noted that when the first symptoms of lactic acidosis appear, a person should immediately be hospitalized. When muscle pain occurs, it is necessary to measure the glycemic level and call the medical team.

Principles of diagnosing a disease

Lactic acidosis is extremely difficult to diagnose. The condition should be confirmed by a number of laboratory tests. Conducted screenings reveal an increased concentration of lactate in the blood and an anionic plasma gap.
The analyzes will also show the following:

high levels of lactate and nitrogen;
low bicarbonate level;
high levels of lactic acid from 6 mmol / l;
critical fat indicators;
decrease in the acidity of the blood substance by less than 7.3.

It is possible to diagnose lactic acidosis only in a hospital setting.

Therapeutic methods

At home, it is impossible to identify and treat the disease. Such attempts always lead to sad consequences. Since the disease develops against the background of oxygen starvation, the therapy is based precisely on its relief with the help of artificial lung ventilation.

Using this technique, the specialist manages to immediately exclude hypoxia as the cause of lactic acidosis. If the patient is in serious condition, the doctor adds sodium bicarbonate to the therapy, but only in case of a critical decrease in the acid indicators of a vital substance (below 7). With drip infusions of bicarbonate, the acidity of the venous blood is monitored every few hours, and when its standard values are reached, the infusions are stopped.

If the patient has renal pathology, hemodialysis is performed. Diabetics are also prescribed insulin therapy to correct metabolic disorders. Vascular and cardiac dosage forms are also introduced. If the acidity of the blood substance is increased, it is reduced with a soda solution by injecting it intravenously until the indicators stabilize.

Detoxification is carried out by droplet injection of plasma, intravenous injections of carboxylase, heparin and rheopolyglucin in the minimum dosage to eliminate thrombosis.

The occurrence of a coma is evidence of incomplete or ineffective diabetes therapy. For this reason, when the crisis has passed, another treatment will be selected for the patient. For a full recovery, he will be prescribed a special dietary diet, bed rest and monitoring of blood counts.

Preventive actions

It is almost impossible to predict the occurrence of lactic acidosis in type 2 diabetes. The life of a patient in this borderline condition depends on timely medical care. Pathology can be diagnosed only in a hospital setting by passing blood biochemistry.

To prevent the development of the disease, diabetics should:

regularly visit an endocrinologist;
completely exclude self-medication;
avoid infectious diseases;
take sugar-stabilizing drugs;
follow a special diet;
timely respond to dangerous symptoms;
control blood glucose levels.

It is important to remember that timely contacting a specialist or calling a medical team will not only prevent a number of serious complications, but also avoid a fatal outcome.

Video: Lactic acidosis in type 2 diabetes - symptoms and prevention

In case of violation of the excretory function of the kidneys, decay products accumulate in the body, tests show an increased concentration of lactic acid. Against the background of the action of provoking factors, in rare cases, lactic acidosis develops in type 2 diabetes mellitus. A dangerous condition in the absence of timely assistance can end badly for the patient.

The diabetic and relatives of the patient should know the main signs of lactic acidosis and the factors that provoke the development of acidotic coma. Basic information about a severe complication of diabetes, first aid and treatment methods for lactic acidosis are described in the article.

What it is

In diabetes mellitus, insulin resistance provokes dysfunction of organs and systems. Against the background of metabolic pathology, renal failure often develops. If the kidneys cannot cope with the load, then harmful substances and toxins accumulate in the body.

With poor compensation for diabetes, self-destruction of glucose in the blood occurs, an excess of lactic acid appears, which accumulates in the body in violation of the processing and excretory function of the kidneys. Supersaturation of blood with lactate provokes blood acidity at the level of 7.3.

Lactic acid negatively affects the supply of organs and tissues with oxygen. With hypoxia, acidosis develops, insulin activity decreases sharply, and lactate levels increase. The more depleted the cells of the pancreas, the more severe the consequences of lactic acidosis.

Doctors confirm the complication of diabetes at a lactic acid concentration of 4 mmol / l or more. It is enough to compare the values with the optimal indicators to see the difference: arterial blood up to 1.6 mmol / l, venous blood no higher than 2.2 mmol. Lactic acidosis, if left untreated, provokes the development of lactic acid coma and death.

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Reasons for development

A dangerous complication develops in a small percentage of the total number of diabetics under the influence of provoking factors. One of the reasons for the violation of the use of antidiabetic compounds, a sharp drop in glucose levels. Drugs of the biguanide group should be taken strictly according to the scheme, with periodic dosage adjustments as directed by the endocrinologist.

Items:

Bahomet,
gliformin,
metformin,
Novoformin,
Metadiene,
Siofor.

In renal failure, severe diseases of the excretory system, biguanides are not prescribed.

Other causes of lactic acidosis against the background of non-insulin dependent diabetes mellitus:

infectious and inflammatory diseases,
administration of a high concentration of glucose intravenously,
hereditary diseases that provoke a violation of metabolic processes,
decompensated diabetes mellitus, difficult to control with medication, in combination with complications of a different nature,
severe anemia,
vitamin B deficiency,
alcohol intoxication,
active blood loss
long-term use of drugs based on salicylic acid, cyanide poisoning,
suffered a stroke or heart attack.

Signs and symptoms

A complex of negative signs in lactic acidosis manifests itself for several hours. When the first symptoms of lactic acidosis appear, urgent hospitalization of the patient is necessary.

The initial stage of development of a dangerous complication signs:

nausea, vomiting,
Strong headache,
myalgia (pain in the muscle tissue),
dizziness, loss of consciousness,
breathing becomes louder, quicker,
impaired coordination of movements,
a person complains of drowsiness or insomnia develops,
discomfort in the abdomen.

In the absence of treatment, the level of lactate in the body rises, oxygen starvation of tissues and brain cells develops. Paresis, violation of physiological reflexes are added to the listed signs.

The next, most dangerous stage is lactic acid coma. During this period, not all patients can be saved: successful therapy is possible in no more than half of the cases.

Specific signs before the development of a life-threatening condition:

dry mucous membranes and epidermis,
kussmaul breathing,
drop in temperature indicators to 35.5 degrees and below,
general weakness,
significant deterioration in general condition,
facial features are sharpened
no excretion of urine
sunken eyeballs,
loss of consciousness,
development of intravascular blood coagulation, the formation of a large number of blood clots (DIC).

Possible consequences

The lack of timely and competent assistance in the development of lactic acidosis provokes the development of diabetic coma. A serious condition is a consequence of active intoxication against the background of stagnation of decay products, a high concentration of lactic acid and dehydration of the body.

The negative impact of pathological processes is enhanced by a violation of protein metabolism, an increase in the level of ammonia and urea. The result is an increase in the concentration of harmful components in the blood and urine, the development of oxygen starvation of the brain.

The phenomena of hypoxia are fraught with dangerous complications:

vascular collapse,
fast, shallow breathing
increased blood clotting,
violation of higher nervous activity,
decreased muscle tone.

Important! The consequence of dangerous processes is the impossibility of the correct course of physiological reactions, which leads to death. It is no coincidence that doctors advise at the first signs of lactic acidosis to call an ambulance for immediate hospitalization, intensive restoration of the basic functions of the body and detoxification.

Diagnostics

When signs of lactic acidosis appear, a medical team should be called. To prevent death, hospitalization of the patient, intensive care is needed. It is important to stabilize the indicators of lactic acid, bicarbonates, fats, blood acidity, and prevent active thrombosis.

The clinic conducts laboratory tests. When confirming lactic acidosis, a violation of many indicators was noted:

blood acidity,
lactic acid level
fat levels,
bicarbonate level,
concentration of nitrogenous substances,
ratio of pyruvic and lactic acids.

General rules and methods of treatment

With the development of complications of type 2 diabetes, urgent medical attention is needed. It is not always possible to predict the development of a severe complication of diabetes. The life of the patient depends on the awareness of relatives who were nearby at the time of the increase in signs of lactic acidosis and the qualifications of the physicians who provide assistance.

First, it is necessary to eliminate hypoxia and manifestations of acidosis, to stabilize the main life support systems. It is important to remove the patient from a state of shock, to ventilate the lungs. If the diabetic is unconscious, then urgent intubation is needed to supply oxygen to the cells of the body.

Physicians eliminate excess blood acidity, neutralize the negative effects of excess lactic acid with sodium bicarbonate solution. The procedures are carried out daily until the stabilization of the main indicators in the body occurs. In one day, the patient receives no more than two liters of alkaline solution.

Additionally, short-acting insulin with glucose, cardiotonic and vasotonic drugs are prescribed to normalize the functions of the heart and vascular system. During treatment, blood tests are needed to assess the concentration of potassium and blood pH.

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The next step is detoxification therapy:

intravenous administration of carboxylase,
correction of insulin therapy,
administration of blood plasma,
to eliminate DIC, small doses of heparin are prescribed,
administration of rheopolyglucin.

After stabilization of the condition, normalization of vital signs, the patient is in the hospital. Be sure to follow a diet, control the dynamics of glucose concentration and blood acidity, measure blood pressure. Upon returning home, you must follow the appointments of the endocrinologist, take hypoglycemic drugs with caution, always use a traditional or non-invasive glucometer.

Lactic acidosis can develop with improper treatment of diabetes mellitus with the use of drugs from the biguanide group. A sharp decrease in glucose levels in combination with renal failure leads to congestion, excess lactic acid, and intoxication of the body.

To prevent lactic acidosis, you need to take biguanides strictly according to the instructions, adjust the dose as prescribed by the doctor, and refuse to independently change the daily norm. When prescribing drugs, it is necessary to conduct a thorough examination of all organs and systems in order to exclude severe pathologies of the urinary system. In the presence of renal insufficiency, it is necessary to select drugs from another group to control glucose levels.

Be sure to measure blood sugar 57 times throughout the day in order to timely identify the risk of hypoglycemia. The likelihood of lactic acidosis is increased with improper treatment of diabetes mellitus, the absence of daily monitoring of glucose levels. Non-compliance with the rules of therapy, unwillingness to use a glucometer, adhere to a diet can lead to a sharp drop in sugar levels, the development of hypoglycemia.

Important points:

against the background of skipping the next dose of a hypoglycemic drug, you can’t take two tablets next time instead of one: hypoglycemia may develop,
with the development of a bacterial or viral infection, you should immediately contact your doctor for adequate therapy. It is not always possible to predict the reaction of a weakened body and an affected pancreas to an antibiotic or antiviral drug. During therapy, you need bed rest, doctor's supervision for timely detection of the risk of lactic acidosis and other negative processes.

With a latent course of endocrine pathology with mild symptoms, you can skip the development of a severe complication. Doctors advise people to study more information if relatives of older generations are diagnosed with diabetes. It is important to know how lactic acidosis develops in type 2 diabetes mellitus, what factors provoke a dangerous complication.

Lactic acidosis in diabetes mellitus develops instantly. A mild onset of a pathological condition in a few hours can turn into a severe form with acute symptoms. Learn how to prevent dangerous complications from the following video:

Reasons for development

Items:

Bahomet,
gliformin,
metformin,
Novoformin,
Metadiene,
Siofor.

In renal failure, severe diseases of the excretory system, biguanides are not prescribed.

Other causes of lactic acidosis against the background of non-insulin dependent diabetes mellitus:

infectious and inflammatory diseases,
administration of a high concentration of glucose intravenously,
hereditary diseases that provoke a violation of metabolic processes,
decompensated diabetes mellitus, difficult to control with medication, in combination with complications of a different nature,
severe anemia,
vitamin B deficiency,
alcohol intoxication,
active blood loss
long-term use of drugs based on salicylic acid, cyanide poisoning,
suffered a stroke or heart attack.

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

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

Lactic acidosis in type 2 diabetes mellitus is a possible severe consequence of the disease. This complication usually occurs in older patients (over 50 years old) with problems of the cardiovascular, urinary and digestive systems. Lactic acidosis rarely starts alone, it is often a component of a diabetic coma.

Factors contributing to the development of the condition:

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

Often the provocateur of lactic acidosis is the intake of drugs, in particular, biguanides, and the decompensation 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, impaired renal function causes intoxication.

Video from Dr. Malysheva about Metformin:

hereditary metabolic disorders (methylmalonic acidemia, type 1 glycogenosis);
parenteral (bypassing the gastrointestinal tract) administration of large doses of fructose;
consumption of ethylene glycol or methanol;
pheochromocytoma (tumor of the adrenal glands);
complicated infectious diseases;
severe damage to the liver and kidneys;
excessive intake of salicylates;
carbon monoxide poisoning;
chronic alcoholism;
massive bleeding;
cyanide poisoning;
shock state;
taking biguanides;
acute anemia;
epilepsy.

Among the etiological reasons, a special place is occupied by long-term use of biguanides. Even a small dose of these drugs (subject to the presence of renal or hepatic dysfunction) can provoke the appearance of lactic acidosis.

Almost half of the cases of lactic acidosis occur in patients with diabetes mellitus.

When a patient is treated with biguanides, the development of lactic acidosis occurs due to impaired penetration of pyruvic acid (pyruvate) through the membranes of cellular mitochondria. In this case, pyruvate actively begins to be converted to lactate. Excess lactic acid enters the bloodstream, then to the liver, where lactic acid is reformed into glycogen. If the liver does not cope with its work, lactic acidosis develops.

The provoking factors affecting the overabundance of lactic acid in the body in diabetes mellitus can be the following reasons:

muscle hypoxia (oxygen starvation) with increased physical exertion;
general respiratory failure (dysfunction);
lack of vitamins (in particular group B);
alcohol intoxication;
severe myocardial infarction;
violation of the kidneys;
acute bleeding;
age from 65 years;
pregnancy.

hypoxia

The main provocateur of the development of lactic acidosis is oxygen starvation (hypoxia). In conditions of a serious lack of oxygen, an active accumulation of lactic acid occurs (an increase in anaerobic glycolysis provokes the accumulation of lactate).

With oxygen-free division of carbohydrates, the activity of the enzyme responsible for the conversion of pyruvic acid to acetylcoenzyme A decreases. In this case, pyruvic acid turns into lactate (lactic acid), which leads to lactic acidosis.

The main causes of occurrence

Lactic acidosis (symptoms and treatment of this disease will be discussed below) may occur due to pathological conditions such as:

infectious and inflammatory diseases;
severe physical injury;
kidney failure;
chronic alcoholism;
acute myocardial infarction;
massive bleeding;
liver disease.

Among other things, among the factors causing lactic acidosis, a special place is taken by the intake of biguanides. So, antihyperglycemic drugs, even in minimal doses, can easily provoke this complication, especially with damage to the liver or kidneys. It should also be noted that the pathology under consideration often occurs with skeletal muscle hypoxia, which develops due to prolonged physical exertion.

The development of lactic acidosis is possible not only in diabetes mellitus, but also in a number of other diseases that are accompanied by a decrease in the supply of oxygen to tissues, while the breakdown of glucose and energy metabolism occurs according to the anaerobic type. It is characterized by a significant formation of lactic acid, which is released into the blood.

Also, a pathological condition occurs in the presence of diseases of organs that utilize and remove lactic acid. This happens with diseases of the kidneys and liver, which are accompanied by a lack of their functioning.

Signs and symptoms

A complex of negative signs in lactic acidosis manifests itself for several hours. When the first symptoms of lactic acidosis appear, urgent hospitalization of the patient is necessary.

The initial stage of development of a dangerous complication signs:

nausea, vomiting,
Strong headache,
myalgia (pain in the muscle tissue),
dizziness, loss of consciousness,
breathing becomes louder, quicker,
impaired coordination of movements,
a person complains of drowsiness or insomnia develops,
discomfort in the abdomen.

In the absence of treatment, the level of lactate in the body rises, oxygen starvation of tissues and brain cells develops. Paresis, violation of physiological reflexes are added to the listed signs.

The next, most dangerous stage is lactic acid coma. During this period, not all patients can be saved: successful therapy is possible in no more than half of the cases.

Specific signs before the development of a life-threatening condition:

dry mucous membranes and epidermis,
kussmaul breathing,
drop in temperature indicators to 35.5 degrees and below,
general weakness,
significant deterioration in general condition,
facial features are sharpened
no excretion of urine
sunken eyeballs,
loss of consciousness,
development of intravascular blood coagulation, the formation of a large number of blood clots (DIC).

Etiology (causes) of lactic acidosis

The following conditions provoke the development of lactic acidosis:

Inflammatory and infectious diseases;
Massive type of bleeding;
Alcoholism in its chronic stage;
Spicy myocardial infarction;
Physical injuries of a severe nature;
kidney failure;
Liver diseases (chronic).

In the total number of factors that cause lactic acidosis and symptoms of the corresponding type, a special place is assigned to the intake of biguanides. In this case, lactic acidosis symptoms occur in diabetic patients taking hypoglycemic drugs with the presence of this substance in the composition. Even its minimum dose with affected kidneys or liver can provoke lactic acidosis, which is facilitated, in particular, by the accumulation of these drugs in the body.

The development of lactic acidosis occurs during hypoxia that occurs in skeletal muscles, which, for example, may be associated with prolonged physical stress. The cause of lactic acidosis without the obvious presence of hypoxia can be leukemia, as well as a number of other types of tumor processes. This also includes respiratory failure, acute heart attack of one of the lungs, intestines, as well as a deficiency in the body of thiamine.

There is a separate number of factors that contribute to the increased production of lactic acid in the tissues of the body, which lead to lactic acidosis, they are referred to.

In this case, there is a decrease in oxygen enrichment of the blood, the lungs do not function with due strength, and all organs begin to suffer from oxygen deficiency. To compensate for the state that has arisen, the cells begin to break down glucose according to the anaerobic type, with the release of lactate.

Leads to the occurrence of lactic acidosis of the same type as pulmonary insufficiency. But in case of violation of the heart, there is a decrease in the volume of blood ejected from its ventricles, which leads to a significant overload of the atria. This provokes an increase in pressure in the small blood circle and turns into acute pulmonary edema, and pulmonary heart failure joins.

The main feature of the kidneys is the release of all unnecessary and toxic substances from the body. Also, the kidneys regulate the concentration of other substances in the body, if there are too many of them, the kidneys begin to remove them more strongly, which happens in a physiological state, with lactic acid. Kidney failure does not give the desired effect, and lactic acid accumulates in the body.

Possible consequences

The lack of timely and competent assistance in the development of lactic acidosis provokes the development of diabetic coma. A serious condition is a consequence of active intoxication against the background of stagnation of decay products, a high concentration of lactic acid and dehydration of the body.

The phenomena of hypoxia are fraught with dangerous complications:

vascular collapse,
fast, shallow breathing
increased blood clotting,
violation of higher nervous activity,
decreased muscle tone.

Important! The consequence of dangerous processes is the impossibility of the correct course of physiological reactions, which leads to death. It is no coincidence that doctors advise at the first signs of lactic acidosis to call an ambulance for immediate hospitalization, intensive restoration of the basic functions of the body and detoxification.

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 staff, which will determine the danger to the patient in time. 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 °, respiratory disorders. Heart failure can lead to myocardial infarction. Collapse occurs - the patient loses consciousness.

The main way to prevent lactic acidosis is the state of diabetes compensation. Taking drugs prescribed by an endocrinologist must be carried out according to the proposed scheme. If you miss a dose, you can not compensate for the lack of an increased dose.

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

It is necessary to keep sugar within the normal range, regularly visit the endocrinologist and take the required tests. When switching to new drugs, you should monitor the condition, not exceeding or reducing the dosage.

It is important to follow the prescribed diet as well as maintain an active lifestyle. This will help improve metabolism and blood supply to organs. A good way to maintain health is sanatorium treatment. Means of modern medicine allow you to keep diabetes mellitus under control.

Diagnostics

When signs of lactic acidosis appear, a medical team should be called. To prevent death, hospitalization of the patient, intensive care is needed. It is important to stabilize the indicators of lactic acid, bicarbonates, fats, blood acidity, and prevent active thrombosis.

The clinic conducts laboratory tests. When confirming lactic acidosis, a violation of many indicators was noted:

blood acidity,
lactic acid level
fat levels,
bicarbonate level,
concentration of nitrogenous substances,
ratio of pyruvic and lactic acids.

Diagnosis of lactic acidosis with the symptoms we mentioned above is rather difficult to determine, although they are taken into account as auxiliary criteria. Reliable nature are laboratory criteria, which are based on the determination in this case of an increase in the content of lactic acid in the blood, as well as a decrease in bicarbonates and reserve alkalinity in it, moderate hyperglycemia and in the absence of acetonuria.

When considering lactic acidosis and its symptoms, treatment is determined primarily for the prompt elimination of hypoxia, as well as the acidosis itself. Emergency care for lactic acidosis and symptoms involves intravenous drip of a solution of sodium bicarbonate (2.5 or 4%) up to 2 l / day.

In this case, pH levels should be kept under control, as well as indicators of potassium levels in the blood. Also mandatory for lactic acidosis and symptoms of treatment is insulin therapy with an intensive genetically engineered nature of the action or monocomponent insulin therapy with a short nature of its action.

As additional components for lactic acidosis and symptoms in the treatment, intravenous carboxylase is used by the drip method with the introduction of about 200 mg / day.

We dealt with the question posed at the beginning of the article: “Lactic acidosis - what is it?” We examined the signs of this deviation. Now we need to talk about how to act in such a situation. If your loved one has at least a few of the above symptoms, you should immediately call a doctor.

It is far from certain that the patient has lactic acidosis. After all, such signs may indicate other whitening. To make a correct diagnosis, it is necessary to do a complete blood count. If an increased content of lactic acid is found in it, as well as reduced rates of bicarbonates and reserve alkalinity, then it makes sense to talk about lactic acidosis.

Lactic acidosis in diabetes mellitus symptoms, treatment

Lactic acidosis is a dangerous pathological condition that occurs when a large amount of lactic acid enters the bloodstream. In this case, the body does not cope with sufficient excretion, which is why it accumulates. This causes a serious violation of the acid-base balance. The body ceases to cope with the ongoing negative changes, the development of lactic acidosis begins.

Pathology can be diagnosed in healthy people (due to certain reasons), as well as in patients with diabetes. In the second case, lactic acidosis (ketoacidosis, diabetic acidosis) is often the result of an uncontrolled course of diabetes.

As a result, the body begins to produce organic acids (ketone bodies) in large quantities. For diabetics, this condition is extremely dangerous, as it can cause hyperlactacidemic coma.

Very often nothing portends the appearance of lactic acidosis. However, in a very short time, just a few hours, symptoms of acute pathology appear. The earliest include: pain in the muscles and behind the sternum, a state of apathy, drowsiness (insomnia), rapid breathing.

Attention! Further, the main symptom of lactic acidosis develops - cardiovascular insufficiency, complicated by high acidity. Further, with the progression of the pathology, abdominal pain appears, accompanied by nausea, vomiting

If you do not take the necessary measures for treatment, the patient's condition worsens greatly.

There is a slow reaction. A person reacts little to the surrounding reality, then generally ceases to notice it. The patient has an involuntary contraction of muscles, convulsions, weakens activity, motor activity.

With the further development of lactic acidosis, a coma occurs. Its harbinger is the appearance of intermittent breathing followed by loss of consciousness.

Treatment of the condition

With this dangerous complication of diabetes, the patient needs urgent medical attention. When placed in a medical institution, he is injected with a drip solution of sodium bicarbonate. At the same time, the level of potassium in the blood is constantly monitored.

A diabetic patient is given additional injections of insulin. If necessary, its daily dosage is adjusted, or the drug used is replaced. Also, in the treatment, a carboxylase solution is used, which is administered by drip, intravenously. According to the doctor's prescription, the introduction of blood plasma is possible. Treatment is with heparin (in small doses).

Lactic acidosis, the symptoms of the treatment, which we discussed with you today, can always be prevented. To do this, use the following recommendations:

First of all, a patient with diabetes should take into account the effect of drugs that reduce sugar on the body. In the absence of certain side diseases, these drugs effectively cope with their task, do not cause any negative consequences.
However, if any disease occurs, infectious, viral, even with a cold, the body's reaction to a drug that reduces sugar can be unpredictable. Therefore, in such cases, a diabetic patient is advised to consult with his doctor.
In particular, lactic acidosis can occur due to the intake of biguanides. Therefore, the doctor prescribes its dosage strictly individually. The patient must strictly follow these instructions, follow all medical recommendations.
In addition, it is necessary to carefully monitor the dynamics of the development of the disease, visit the doctor regularly, take the necessary tests on time. At the slightest suspicion of the development of lactic acidosis, it is necessary to visit an endocrinologist as soon as possible. Be healthy!

General rules and methods of treatment

With the development of complications of type 2 diabetes, urgent medical attention is needed. It is not always possible to predict the development of a severe complication of diabetes. The life of the patient depends on the awareness of relatives who were nearby at the time of the increase in signs of lactic acidosis and the qualifications of the physicians who provide assistance.

Additionally, short-acting insulin with glucose, cardiotonic and vasotonic drugs are prescribed to normalize the functions of the heart and vascular system. During treatment, blood tests are needed to assess the concentration of potassium and blood pH.

First, you need to eliminate hypoxia and manifestations of acidosis, stabilize the main life support systems

It is important to remove the patient from a state of shock, to ventilate the lungs. If the diabetic is unconscious, then urgent intubation is needed to supply oxygen to the cells of the body

Learn about preventing diabetes in children and adults, and read helpful tips from experts.

About the rules and features of dieting for hypothyroidism of the thyroid gland is written in this article.

So, the topic of our conversation is lactic acidosis. What is it and how to treat it? This is a deviation in which hyperlactacidemic coma is provoked. This complication is especially important for patients with diabetes mellitus. After all, the accumulation of lactic acid in the body (in the skin, brain, skeletal muscles, etc.)

Important points:

against the background of skipping the next dose of a hypoglycemic drug, you can’t take two tablets next time instead of one: hypoglycemia may develop,

Be sure to measure blood sugar 5-7 times throughout the day in order to identify the risk in a timely manner. The likelihood of lactic acidosis is increased with improper treatment of diabetes mellitus, the absence of daily monitoring of glucose levels. Non-compliance with the rules of therapy, unwillingness to use a glucometer, adhere to a diet can lead to a sharp drop in sugar levels, the development of hypoglycemia.

Important points:

against the background of skipping the next dose of a hypoglycemic drug, you should not take two tablets next time instead of one: hypoglycemia may develop;
with the development of a bacterial or viral infection, you should immediately contact your doctor for adequate therapy. It is not always possible to predict the reaction of a weakened body and an affected pancreas to an antibiotic or antiviral drug. During therapy, you need bed rest, doctor's supervision for timely detection of the risk of lactic acidosis and other negative processes.

It is important to know how lactic acidosis develops in type 2 diabetes mellitus, what factors provoke a dangerous complication.

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

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

Acidosis is a condition in which there is an increased amount of acids in the blood.

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

What is lactic acidosis?

Lactic acidosis (lactate acidosis) is an increase in the content of lactic acid in the blood. This leads to its excessive production and impaired excretion from the body by the kidneys and liver. This is a rather rare condition, which is a consequence of some diseases.

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

Lactic acid is a product of glucose processing in the body. Oxygen is not needed for its synthesis, it is formed during anaerobic metabolism. Most of the acid enters the bloodstream from the muscles, bones, and skin.

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

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

The control of lactates is necessary for athletes, since their growth is possible at high loads.

There are two types of lactic acidosis:

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

Lactic acidosis is generally caused by:

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

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

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

For adults, the normal content in the blood 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 glucose metabolism develops.

Factors contributing to the development of the condition:

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

Often a provocateur of lactic acidosis is taking medications, in particular, and the decompensation 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, 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 - fatigue, fatigue, drowsiness, there are also signs of dyspepsia, nausea and vomiting. These symptoms are similar to uncontrolled diabetes mellitus.

An excess of 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 similar to myalgic, radiates to the chest. All other signs are not specific, therefore, they are often interpreted incorrectly.

The launched process of secretion of lactic acid develops very quickly, the patient's condition is rapidly deteriorating. Several hours pass before hyperlactocidemia coma. During this time, numerous disorders of the body develop - the central and peripheral nervous systems, respiration.

The patient has:

dyspeptic disorders;
decrease in urine production up to cessation;
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 the possible development of necrosis in the limbs;
cardiac arrhythmias, deterioration of the heart;
loss of orientation, stupor;
dry skin, thirst;
drop in blood pressure, decrease in body temperature;
disorders of the peripheral nervous system cause convulsions and loss of reflexes.

The condition differs from ketoacidosis by the absence of the smell of acetone on exhalation. Cardiac disorders are difficult to correct with drugs. A coma may develop within a few hours.

First aid and treatment

The symptoms of lactic acidosis are mostly non-specific, so the patient should quickly do a blood test. Assistance can only be provided in a hospital setting. It is necessary to differentiate the state with ketoacidosis and uremic acidosis.

The state of lactic acidosis is evidenced by:

The level of lactates is above 5 mmol / l.
Decreased bicarbonate and blood pH.
Increased anion gap in plasma.
Increase in residual nitrogen.
Hyperlipidemia.
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 can stop the development of coma.

In the treatment, two main actions are required - the elimination of hypoxia and a decrease in the level of lactic acid and its formation.

Saturation of tissues with oxygen helps to 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 the withdrawal of 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 dripped. Its entry is carried out very slowly over several hours.

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

During therapy, Heparin is also used to prevent thrombosis, drugs of the carboxylase group, Reopoliglyukin.

The introduction of insulin is not required, it is usually used in small doses 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 staff, which will determine the danger to the patient in time. Urgent testing is also required.

It is important to follow the prescribed diet as well as maintain an active lifestyle. This will help improve metabolism and blood supply to organs. A good way to maintain health is. Means of modern medicine allow you to keep diabetes mellitus under control.