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Lactic Acidosis Pdf

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An Error Occurred Setting Your User Cookie This site uses cookies to improve performance. If your browser does not accept cookies, you cannot view this site. There are many reasons why a cookie could not be set correctly. Below are the most common reasons: You have cookies disabled in your browser. You need to reset your browser to accept cookies or to ask you if you want to accept cookies. Your browser asks you whether you want to accept cookies and you declined. To accept cookies from this site, use the Back button and accept the cookie. Your browser does not support cookies. Try a different browser if you suspect this. The date on your computer is in the past. If your computer's clock shows a date before 1 Jan 1970, the browser will automatically forget the cookie. To fix this, set the correct time and date on your computer. You have installed an application that monitors or blocks cookies from being set. You must disable the application while logging in or check with your system administrator. This site uses cookies to improve performance by remembering that you are logged in when you go from page to page. To provide access without cookies would require the site to create a new session for every page you visit, which slows the system down to an unacceptable level. This site stores nothing other than an automatically generated session ID in the cookie; no other information is captured. In general, only the information that you provide, or the choices you make while visiting a web site, can be stored in a cookie. For example, the site cannot determine your email name unless you choose to type it. Allowing a website to create a cookie does not give that or any other site access to the rest of your computer, and only the site that created the cookie can read it. Continue reading >>

Lactic Acidosis In Hiv Infected Patients: A Systematic Review Of Published Cases.

Lactic Acidosis In Hiv Infected Patients: A Systematic Review Of Published Cases.

1. Sex Transm Infect. 2003 Aug;79(4):340-3. Lactic acidosis in HIV infected patients: a systematic review of published cases. Arenas-Pinto A(1), Grant AD, Edwards S, Weller IV. (1)Department of Sexually Transmitted Diseases, Royal Free and University College Medical School, University College London, UK. [email protected] OBJECTIVE: To describe the clinical, epidemiological, and biochemicalcharacteristics of published cases of lactic acidosis (LA) and to generatehypotheses concerning risk factors associated with this complication.METHODS: Systematic review of cases reported in the medical literature.RESULTS: 217 published cases were identified, 90 of which fulfilled the studydefinition and had sufficient individual data on potential risk factors to beincluded. The 90 patients had a mean age of 40.1 years (range 16-69) and 53% werefemale. All 90 patients were taking nucleoside reverse transcriptase inhibitors(NRTI) at the time of the episode. Among the 83 patients with details of theirantiretroviral therapy (ART) regimen 51 patients were taking stavudine, 29zidovudine, 27 didanosine, and 25 lamivudine. Around 50% of the patients hadabdominal pain, nausea, or vomiting. Hepatic steatosis was consistently reported (53/90) and in 36 (68%) there was histological evidence. The case fatality ratewas 48%. Six cases were rechallenged with NRTI and three developed a further LAepisode. Using data on the numbers of HIV infected individuals receiving care in the United States, we estimate that the risk of LA could be 2.5 times higher for women than men.CONCLUSIONS: NRTI use and female sex appear to be risk factors for thedevelopment of LA. What other factors are involved is still not clear but mightinclude duration of NRTI therapy, specific drug use, and genetic predisposi Continue reading >>

Chronic Lactic Acidosis In An Adult: A New Syndrome Associated With An Altered Redox State Of Certain Nad/nadh Coupled Reactions - Sciencedirect

Chronic Lactic Acidosis In An Adult: A New Syndrome Associated With An Altered Redox State Of Certain Nad/nadh Coupled Reactions - Sciencedirect

Volume 48, Issue 1 , January 1970, Pages 104-112 Chronic lactic acidosis in an adult: A new syndrome associated with an altered redox state of certain NAD/NADH coupled reactions Author links open overlay panel Karl E.SussmanM.D. Get rights and content Chronically elevated blood lactic acid, pyruvic acid and increased L:P ratios have been found in a twenty-eight year old woman with episodic acidosis. The patient has no other associated disease. Alcohol ingestion increases the hyperlacticacidemia and exacerbates the patient's symptoms of weakness and easy fatiguability. Moderate exercise increases blood lactic acid levels from 3,1 to 10.2 M per ml and lowers arterial blood pH from 7.4 to 7.26. Hyperuricemia is present due to depressed uric acid clearance. Certain NAD/NADH coupled metabolic reactions are clearly shifted towards the reduced state (lactate/pyruvate, -glycerophosphate dihydroxyacetone phosphate and galactose-glucose interconversion). Skeletal muscle and liver demonstrate normal total NAD/NADH content and partition of these pyridine nucleotides. Four members of the patient's maternal family have an abnormal lactate response to the combination of alcohol ingestion and exercise, suggesting that this defect may be an inherited disorder. Continue reading >>

Metabolic Acidosis Treatment & Management

Metabolic Acidosis Treatment & Management

Approach Considerations Treatment of acute metabolic acidosis by alkali therapy is usually indicated to raise and maintain the plasma pH to greater than 7.20. In the following two circumstances this is particularly important. When the serum pH is below 7.20, a continued fall in the serum HCO3- level may result in a significant drop in pH. This is especially true when the PCO2 is close to the lower limit of compensation, which in an otherwise healthy young individual is approximately 15 mm Hg. With increasing age and other complicating illnesses, the limit of compensation is likely to be less. A further small drop in HCO3- at this point thus is not matched by a corresponding fall in PaCO2, and rapid decompensation can occur. For example, in a patient with metabolic acidosis with a serum HCO3- level of 9 mEq/L and a maximally compensated PCO2 of 20 mm Hg, a drop in the serum HCO3- level to 7 mEq/L results in a change in pH from 7.28 to 7.16. A second situation in which HCO3- correction should be considered is in well-compensated metabolic acidosis with impending respiratory failure. As metabolic acidosis continues in some patients, the increased ventilatory drive to lower the PaCO2 may not be sustainable because of respiratory muscle fatigue. In this situation, a PaCO2 that starts to rise may change the plasma pH dramatically even without a significant further fall in HCO3-. For example, in a patient with metabolic acidosis with a serum HCO3- level of 15 and a compensated PaCO2 of 27 mm Hg, a rise in PaCO2 to 37 mm Hg results in a change in pH from 7.33 to 7.20. A further rise of the PaCO2 to 43 mm Hg drops the pH to 7.14. All of this would have occurred while the serum HCO3- level remained at 15 mEq/L. In lactic acidosis and diabetic ketoacidosis, the organic anion can r Continue reading >>

Lactic Acidosis And Status Asthmaticus: How Common In Pediatrics? - Sciencedirect

Lactic Acidosis And Status Asthmaticus: How Common In Pediatrics? - Sciencedirect

Volume 89, Issue 6 , December 2002, Pages 585-588 Lactic acidosis and status asthmaticus: how common in pediatrics? Author links open overlay panel EjazYousefMD Get rights and content Lactic acidosis is a well described phenomenon in adult patients with severe asthma. However, this entity is rarely reported in children with status asthmaticus. To report our experience in a 13-year-old girl who developed lactic acidosis as a complication of status asthmaticus and to investigate the prevalence of this complication of severe asthma. We sought to determine the frequency of lactic acidosis in such patients and to review etiologies of lactic acidosis. 1) Observations on the clinical and laboratory findings in an adolescent girl with status asthmaticus who developed lactic acidosis were recorded. 2) The medical records of 100 children and adolescents with status asthmaticus admitted to an intensive care unit were reviewed for laboratory evidence of lactic acidosis. 3) We also reviewed our own previous experience of status asthmaticus with respiratory failure. Among 100 patients admitted to a pediatric intensive care unit for status asthmaticus, a single case of isolated metabolic acidosis was identified. This proved to be attributable to lactic acidosis. When records of patients with severe respiratory failure were examined, no cases of metabolic acidosis were found. Although rare, lactic acidosis does occur in pediatric-aged patients during status asthmaticus. It is important that this complication be recognized and treated because acidosis may inhibit the effectiveness of bronchodilator therapy, produce electrolyte disturbances, and cause serious adverse effects on the patient's cardiovascular system. Continue reading >>

Lactic Acidosis

Lactic Acidosis

Lactic acidosis is a medical condition characterized by the buildup of lactate (especially L-lactate) in the body, which results in an excessively low pH in the bloodstream. It is a form of metabolic acidosis, in which excessive acid accumulates due to a problem with the body's metabolism of lactic acid. Lactic acidosis is typically the result of an underlying acute or chronic medical condition, medication, or poisoning. The symptoms are generally attributable to these underlying causes, but may include nausea, vomiting, rapid deep breathing, and generalised weakness. The diagnosis is made on biochemical analysis of blood (often initially on arterial blood gas samples), and once confirmed, generally prompts an investigation to establish the underlying cause to treat the acidosis. In some situations, hemofiltration (purification of the blood) is temporarily required. In rare chronic forms of lactic acidosis caused by mitochondrial disease, a specific diet or dichloroacetate may be used. The prognosis of lactic acidosis depends largely on the underlying cause; in some situations (such as severe infections), it indicates an increased risk of death. Classification[edit] The Cohen-Woods classification categorizes causes of lactic acidosis as:[1] Type A: Decreased tissue oxygenation (e.g., from decreased blood flow) Type B B1: Underlying diseases (sometimes causing type A) B2: Medication or intoxication B3: Inborn error of metabolism Signs and symptoms[edit] Lactic acidosis is commonly found in people who are unwell, such as those with severe heart and/or lung disease, a severe infection with sepsis, the systemic inflammatory response syndrome due to another cause, severe physical trauma, or severe depletion of body fluids.[2] Symptoms in humans include all those of typical m Continue reading >>

Lactate And Lactic Acidosis

Lactate And Lactic Acidosis

The integrity and function of all cells depend on an adequate supply of oxygen. Severe acute illness is frequently associated with inadequate tissue perfusion and/or reduced amount of oxygen in blood (hypoxemia) leading to tissue hypoxia. If not reversed, tissue hypoxia can rapidly progress to multiorgan failure and death. For this reason a major imperative of critical care is to monitor tissue oxygenation so that timely intervention directed at restoring an adequate supply of oxygen can be implemented. Measurement of blood lactate concentration has traditionally been used to monitor tissue oxygenation, a utility based on the wisdom gleaned over 50 years ago that cells deprived of adequate oxygen produce excessive quantities of lactate. The real-time monitoring of blood lactate concentration necessary in a critical care setting was only made possible by the development of electrode-based lactate biosensors around a decade ago. These biosensors are now incorporated into modern blood gas analyzers and other point-of-care analytical instruments, allowing lactate measurement by non-laboratory staff on a drop (100 L) of blood within a minute or two. Whilst blood lactate concentration is invariably raised in those with significant tissue hypoxia, it can also be raised in a number of conditions not associated with tissue hypoxia. Very often patients with raised blood lactate concentration (hyperlactatemia) also have a reduced blood pH (acidosis). The combination of hyperlactatemia and acidosis is called lactic acidosis. This is the most common cause of metabolic acidosis. The focus of this article is the causes and clinical significance of hyperlactatemia and lactic acidosis. The article begins with a brief overview of normal lactate metabolism. Normal lactate production and Continue reading >>

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