diabetestalk.net

Lactic Acidosis Symptoms Nhs

Diabetic Ketoacidosis

Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a serious problem that can occur in people with diabetes if their body starts to run out of insulin. This causes harmful substances called ketones to build up in the body, which can be life-threatening if not spotted and treated quickly. DKA mainly affects people with type 1 diabetes, but can sometimes occur in people with type 2 diabetes. If you have diabetes, it's important to be aware of the risk and know what to do if DKA occurs. Symptoms of diabetic ketoacidosis Signs of DKA include: needing to pee more than usual being sick breath that smells fruity (like pear drop sweets or nail varnish) deep or fast breathing feeling very tired or sleepy passing out DKA can also cause high blood sugar (hyperglycaemia) and a high level of ketones in your blood or urine, which you can check for using home-testing kits. Symptoms usually develop over 24 hours, but can come on faster. Check your blood sugar and ketone levels Check your blood sugar level if you have symptoms of DKA. If your blood sugar is 11mmol/L or over and you have a blood or urine ketone testing kit, check your ketone level. If you do a blood ketone test: lower than 0.6mmol/L is a normal reading 0.6 to 1.5mmol/L means you're at a slightly increased risk of DKA and should test again in a couple of hours 1.6 to 2.9mmol/L means you're at an increased risk of DKA and should contact your diabetes team or GP as soon as possible 3mmol/L or over means you have a very high risk of DKA and should get medical help immediately If you do a urine ketone test, a result of more than 2+ means there's a high chance you have DKA. When to get medical help Go to your nearest accident and emergency (A&E) department straight away if you think you have DKA, especially if you have a high level of ketones in Continue reading >>

Metformin Associated Lactic Acidosis

Metformin Associated Lactic Acidosis

Metformin, a dimethylbiguanide, is a widely used oral antihyperglycaemic drug used in the long term treatment of type 2 diabetes mellitus. More recently it has also been used to improve fertility and weight reduction in patients with polycystic ovary syndrome. Many large studies have shown that intensive glucose control with metformin in overweight patients with type 2 diabetes is associated with risk reductions of 32% (P=0.002) for any diabetes related end point, 42% (P=0.017) for diabetes related death, and 36% (P=0.011) for all cause mortality compared with diet alone.1 Furthermore, metformin reduces microvascular end points, and its degree of glycaemic control is similar to that sulphonylureas and insulin. Metformin is considered to be first line treatment in overweight patients with type 2 diabetes whose blood glucose is inadequately controlled by lifestyle interventions alone and should be considered as a first line glucose lowering treatment in non-overweight patients with type 2 diabetes because of its other beneficial effects.2 It may also be useful in overweight patients with type 1 diabetes. A potential complication of metformin is the development of type B (non-hypoxic) lactic acidosis. Although metformin associated lactic acidosis is a rare condition, with an estimated prevalence of one to five cases per 100 000 population,3 it has a reported mortality of 30-50%.4 Prognosis seems to be unrelated to plasma metformin concentration or lactate level.5 We present a report on a patient with type 2 diabetes who was receiving long term treatment with metformin and developed severe metformin associated lactic acidosis after dehydration, which resulted in renal impairment and consequent accumulation of metformin. This case illustrates the importance of stopping metfo Continue reading >>

Metformin Associated Lactic Acidosis

Metformin Associated Lactic Acidosis

Emma Fitzgerald, specialist trainee year 2 in anaesthetics 1, Stephen Mathieu, specialist registrar in anaesthetics and intensive care medicine1, Andrew Ball, consultant in anaesthesia and intensive care medicine1 1Dorset County Hospital, Dorchester, Dorset DT1 2JY Correspondence to: E Fitzgerald zcharm6{at}hotmail.com Dehydration in patients taking metformin can lead to metformin associated lactic acidosis, a potentially fatal condition Metformin, a dimethylbiguanide, is a widely used oral antihyperglycaemic drug used in the long term treatment of type 2 diabetes mellitus. More recently it has also been used to improve fertility and weight reduction in patients with polycystic ovary syndrome. Many large studies have shown that intensive glucose control with metformin in overweight patients with type 2 diabetes is associated with risk reductions of 32% (P=0.002) for any diabetes related end point, 42% (P=0.017) for diabetes related death, and 36% (P=0.011) for all cause mortality compared with diet alone.1 Furthermore, metformin reduces microvascular end points, and its degree of glycaemic control is similar to that sulphonylureas and insulin. Metformin is considered to be first line treatment in overweight patients with type 2 diabetes whose blood glucose is inadequately controlled by lifestyle interventions alone and should be considered as a first line glucose lowering treatment in non-overweight patients with type 2 diabetes because of its other beneficial effects.2 It may also be useful in overweight patients with type 1 diabetes. A potential complication of metformin is the development of type B (non-hypoxic) lactic acidosis. Although metformin associated lactic acidosis is a rare condition, with an estimated prevalence of one to five cases per 100 000 population Continue reading >>

Lactic Acidosis: What You Need To Know

Lactic Acidosis: What You Need To Know

Lactic acidosis is a form of metabolic acidosis that begins in the kidneys. People with lactic acidosis have kidneys that are unable to remove excess acid from their body. If lactic acid builds up in the body more quickly than it can be removed, acidity levels in bodily fluids — such as blood — spike. This buildup of acid causes an imbalance in the body’s pH level, which should always be slightly alkaline instead of acidic. There are a few different types of acidosis. Lactic acid buildup occurs when there’s not enough oxygen in the muscles to break down glucose and glycogen. This is called anaerobic metabolism. There are two types of lactic acid: L-lactate and D-lactate. Most forms of lactic acidosis are caused by too much L-lactate. Lactic acidosis has many causes and can often be treated. But if left untreated, it may be life-threatening. The symptoms of lactic acidosis are typical of many health issues. If you experience any of these symptoms, you should contact your doctor immediately. Your doctor can help determine the root cause. Several symptoms of lactic acidosis represent a medical emergency: fruity-smelling breath (a possible indication of a serious complication of diabetes, called ketoacidosis) confusion jaundice (yellowing of the skin or the whites of the eyes) trouble breathing or shallow, rapid breathing If you know or suspect that you have lactic acidosis and have any of these symptoms, call 911 or go to an emergency room right away. Other lactic acidosis symptoms include: exhaustion or extreme fatigue muscle cramps or pain body weakness overall feelings of physical discomfort abdominal pain or discomfort diarrhea decrease in appetite headache rapid heart rate Lactic acidosis has a wide range of underlying causes, including carbon monoxide poisoni Continue reading >>

Diabetes And Metformin Faqs

Diabetes And Metformin Faqs

Tweet Although one of the most common drugs for type 2 diabetics, Metformin can still confuse diabetic patients. This set of FAQs are intended for information purposes, and should not replace or supersede the advice of a doctor or qualified medical professional. If you have a question about diabetes and Metformin that is not covered here, please ask the community in the Diabetes forum. Should all type 2 diabetics take Meformin? One side effect of taking Metformin is lactic acidosis, and for this reason some diabetics should not take Metformin unless specifically advised to do so by their GP or diabetes healthcare team. For this reason, diabetics with kidney problems, liver problems, and heart problems are often advised to avoid Metformin. Similarly, diabetics that are dehydrated, drink alcohol a lot, or are going to have an x-ray or surgery. For some pregnant diabetics, Metformin may not be the best choice, but in all instances this should be discussed with your doctor. Can young diabetics take Metformin? Metformin has been proven in clinical trials to lower glucose levels amongst children between 10-16 years of age suffering from type 2 diabetes. Research is less conclusive about children under 10 and children taking Metformin alongside other treatments, but your diabetes health care team should be able to elaborate on this. How much Metformin should I take? This will depend entirely on your condition, and your doctor will be able to tell you how much Metformin to take, when you should take it, and how you should take it. Usually, diabetics start out on a low dose of Metformin, and this is slowly increased until blood sugar responds. Doctors often put diabetics on combination courses with other medication, including insulin. If I take Metformin, can I stop my diet and Continue reading >>

Glyburide And Metformin (oral Route)

Glyburide And Metformin (oral Route)

Precautions Drug information provided by: Micromedex It is very important that your doctor check your progress at regular visits to make sure this medicine is working properly. Blood tests may be needed to check for unwanted effects. Under certain conditions, too much metformin can cause lactic acidosis. The symptoms of lactic acidosis are severe and quick to appear. They usually occur when other health problems not related to the medicine are present and very severe, such as a heart attack or kidney failure. The symptoms of lactic acidosis include abdominal or stomach discomfort; decreased appetite; diarrhea; fast, shallow breathing; a general feeling of discomfort; muscle pain or cramping; and unusual sleepiness, tiredness, or weakness. If you have any symptoms of lactic acidosis, get emergency medical help right away. It is very important to carefully follow any instructions from your health care team about: Alcohol—Drinking alcohol may cause severe low blood sugar. Discuss this with your health care team. Other medicines—Do not take other medicines unless they have been discussed with your doctor. This especially includes nonprescription medicines such as aspirin, and medicines for appetite control, asthma, colds, cough, hay fever, or sinus problems. Counseling—Other family members need to learn how to prevent side effects or help with side effects if they occur. Also, patients with diabetes may need special counseling about diabetes medicine dosing changes that might occur because of lifestyle changes, such as changes in exercise and diet. Furthermore, counseling on contraception and pregnancy may be needed because of the problems that can occur in patients with diabetes during pregnancy. Travel—Keep your recent prescription and your medical history with yo Continue reading >>

Lactic Acidosis And Exercise: What You Need To Know

Lactic Acidosis And Exercise: What You Need To Know

Muscle ache, burning, rapid breathing, nausea, stomach pain: If you've experienced the unpleasant feeling of lactic acidosis, you likely remember it. It's temporary. It happens when too much acid builds up in your bloodstream. The most common reason it happens is intense exercise. Symptoms The symptoms may include a burning feeling in your muscles, cramps, nausea, weakness, and feeling exhausted. It's your body's way to tell you to stop what you're doing The symptoms happen in the moment. The soreness you sometimes feel in your muscles a day or two after an intense workout isn't from lactic acidosis. It's your muscles recovering from the workout you gave them. Intense Exercise. When you exercise, your body uses oxygen to break down glucose for energy. During intense exercise, there may not be enough oxygen available to complete the process, so a substance called lactate is made. Your body can convert this lactate to energy without using oxygen. But this lactate or lactic acid can build up in your bloodstream faster than you can burn it off. The point when lactic acid starts to build up is called the "lactate threshold." Some medical conditions can also bring on lactic acidosis, including: Vitamin B deficiency Shock Some drugs, including metformin, a drug used to treat diabetes, and all nucleoside reverse transcriptase inhibitor (NRTI) drugs used to treat HIV/AIDS can cause lactic acidosis. If you are on any of these medications and have any symptoms of lactic acidosis, get medical help immediately. Preventing Lactic Acidosis Begin any exercise routine gradually. Pace yourself. Don't go from being a couch potato to trying to run a marathon in a week. Start with an aerobic exercise like running or fast walking. You can build up your pace and distance slowly. Increase the Continue reading >>

Lactic Acidosis And Exercise

Lactic Acidosis And Exercise

Lactic acid builds up naturally in the muscles during vigorous activity. Sometimes if we've overdone it during a workout or run, the body can't clear lactic acid or lactate quickly enough, and lactic acid levels build up. Lactic acid can irritate muscles, causing discomfort and soreness. Sore muscles after exercising is called delayed onset muscle soreness or DOMS. Lactic acid is just one cause of DOMS. Because lactic acid is removed from muscles between a few hours to under a day after a workout, it can't be blamed for lasting soreness some days after working out. Cooling down or warming down after exercise can help remove the lactic acid as well as letting the heart rate slow down more gradually. Some severe medical conditions can also cause lactic acidosis, which can be dangerous. During exercise, muscles metabolise glucose (sugar) into energy. Muscles receive glucose continually through the blood, and also have their own stores of sugar (called glycogen). Every person has an upper limit of exercise ability, called the anaerobic threshold or lactate threshold. The lactate threshold is basically a measurement of how fit the heart and blood vessels are. With regular exercise training, a persons lactate threshold goes up. Exercising at an intensity level below the lactate threshold produces very little lactic acid and the body quickly clears what is produced. A person can exercise below the lactate threshold for a long time, even for hours. Once the intensity of exercise exceeds the lactate threshold, muscles begin to use glucose inefficiently, through alternative chemical reactions. Lactic acid is produced and can rapidly build up in the blood and muscles. When a person's exercise intensity crosses the lactate threshold the activity rapidly becomes much more difficult Continue reading >>

Barth Syndrome As The Cause Of Hypoglycaemia And/or Lactic Acidosis

Barth Syndrome As The Cause Of Hypoglycaemia And/or Lactic Acidosis

Neonatal hypoglycaemia and lactic acidosis Hypoglycaemia and lactic acidosis in response to infection Boys with Barth Syndrome are prone todeveloping a low blood sugar ( hypoglycaemia, hypoglycemia [US]) and acidicblood due to a build-up of lactic acid, especially during neonatallife and infancy. Lactic acidosis is particularly common whensevere heart failure occurs.However, it is well recognised thatboys with Barth Syndrome can develop hypoglycaemia and/or lacticacidosis without heart failure being apparent, especially duringviral infections which cause vomiting or prevent feeding. This isespecially the case with viral gastroenteritis which can be a veryimportant precipitating factor and may require early hospitaladmission for intravenous supplements. The potential forhypoglycaemia is probably partly due to the low muscle mass presentin many boys. Hypoglycaemia can be life-threatening, causingdrowsiness or coma, when the blood glucose falls to less than 1.5mmol/l (27mg/dl). It can also make boys wake up in the morningfeeling unwell with headache. Barth Syndrome could potentially be confusedwith other biochemical diseases which produce hypoglycaemia inresponse to infective stress. This includes mitochondrial diseasesand Medium Chain Acyl-CoA Dehydrogenase Deficiency(MCADD) and related disorders. Continue reading >>

Lactic Acidosis

Lactic Acidosis

Patient professional reference Professional Reference articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use. You may find one of our health articles more useful. Description Lactic acidosis is a form of metabolic acidosis due to the inadequate clearance of lactic acid from the blood. Lactate is a byproduct of anaerobic respiration and is normally cleared from the blood by the liver, kidney and skeletal muscle. Lactic acidosis occurs when the body's buffering systems are overloaded and tends to cause a pH of ≤7.25 with plasma lactate ≥5 mmol/L. It is usually caused by a state of tissue hypoperfusion and/or hypoxia. This causes pyruvic acid to be preferentially converted to lactate during anaerobic respiration. Hyperlactataemia is defined as plasma lactate >2 mmol/L. Classification Cohen and Woods devised the following system in 1976 and it is still widely used:[1] Type A: lactic acidosis occurs with clinical evidence of tissue hypoperfusion or hypoxia. Type B: lactic acidosis occurs without clinical evidence of tissue hypoperfusion or hypoxia. It is further subdivided into: Type B1: due to underlying disease. Type B2: due to effects of drugs or toxins. Type B3: due to inborn or acquired errors of metabolism. Epidemiology The prevalence is very difficult to estimate, as it occurs in critically ill patients, who are not often suitable subjects for research. It is certainly a common occurrence in patients in high-dependency areas of hospitals.[2] The incidence of symptomatic hyperlactataemia appears to be rising as a consequence of the use of antiretroviral therapy to treat HIV infection. It appears to increase in those taking stavudine (d4T) regimens.[3] Causes of lactic acid Continue reading >>

Case Report: A Rare Cause Of Severe Lactic Acidosis

Case Report: A Rare Cause Of Severe Lactic Acidosis

1Department of Acute Medicine and Elderly Care, Walsall Healthcare NHS Trust, Walsall, West Midlands, UK 2Department of Intensive Care Medicine, Walsall Healthcare NHS Trust, Walsall, West Midlands, UK 3Department of Anaesthetics, Walsall Healthcare NHS Trust, Walsall, West Midlands, UK 4Department of Acute Medicine, City Hospital, Birmingham, West Midlands, UK Correspondence to Dr Saad Saeed, [email protected] Sarcoidosis is a multisystem disease of unknown aetiology with a classic histology of non-caseating granulomas. It most often occurs in those below the age of 50 years, and has a female preponderance. The main targets, often symptomless, are the lung and hilar lymph nodes, although liver involvement is not uncommon. Hepatic sarcoidosis encompasses a broad spectrum of presentations, from asymptomatic hepatic granulomas with slight liver function test derangement to severe liver involvement with cholestasis, advanced liver cirrhosis or chronic liver failure. Mortality due to acute liver failure is far less common than lung and heart involvement. We describe a case of fulminant liver failure with multiorgan failure presenting initially with chronic non-specific symptoms, in addition to minimal abnormal investigations such as mild anaemia, neutrophil leucocytosis and mild obstructive liver dysfunction. Presenting features included confusion, hypotension, oliguria and rapidly deteriorating liver function with severe lactic acidosis. Postmortem examination confirmed extensive systemic sarcoidosis. Though deranged liver function is not uncommon in acute medical patients, we believe sarcoidosis should be considered as a differential diagnoses in such patients. Systemic sarcoidosis was not considered during our patient's illness. Postmortem examination, how Continue reading >>

Life Threatening Lactic Acidosis

Life Threatening Lactic Acidosis

M Lemyze, specialist registrar in critical care medicine 1 , J F Baudry, specialist registrar in critical care medicine 2 , F Collet, specialist registrar in critical care medicine 2 , N Guinard, specialist registrar in critical care medicine 2 1Department of Critical Care Medicine, Schaffner Hospital, 62300 Lens, France 2Department of Critical Care Medicine, Broussais Hospital, 35400 Saint Malo, France Correspondence to: M Lemyze malcolmlemyze{at}yahoo.fr An 83 year old woman with diabetes presented to the emergency department with progressive shortness of breath and a two week history of diarrhoea. Her drugs included aspirin, 75 mg four times a day; a combination of irbesartan with hydrochlorothiazide, 300/25 mg four times a day; and metformin, 1000 mg three times a day. She had no previously known renal insufficiency, but on arrival she was oliguric, disoriented, and confused. Her respiratory rate was 32 breaths/min, blood pressure was 76/46 mm Hg, heart rate was 125 beats/min, and rectal temperature reached 36.8C. She had cool and clammy extremities and a persistent skinfoldadditional evidence of severe dehydration. Arterial blood gases showed a profound lactic acidosis, with pH 6.72, partial pressure of carbon dioxide (PCO2) 14 mm Hg, partial pressure of oxygen (PO2) 106 mm Hg, bicarbonate 12 mmol/l, and a high lactate concentration of 17.4 mmol/l. Laboratory results showed a normal blood glucose concentration of 9 mmol/l, a serum urea of 22 mmol/l, a serum creatinine of 779 mol/l, an increased serum potassium concentration of 6.8 mmol/l, and a decreased prothrombin activity of 43% (prothrombin time of 21 seconds). Chest and abdominal examination, chest radiography, urine dipstick, plasma C reactive protein (<5 mg/l), and procalcitonin (<0.5 g/l) concentrations sh Continue reading >>

Lactic Acidosis Clinical Presentation: History, Physical Examination

Lactic Acidosis Clinical Presentation: History, Physical Examination

Author: Kyle J Gunnerson, MD; Chief Editor: Michael R Pinsky, MD, CM, Dr(HC), FCCP, MCCM more... The onset of acidosis may be rapid (ie, within minutes to hours) or progressive (ie, over a period of several days). Lactic acidosis frequently occurs during strenuous exercise in healthy people, bearing no consequence. However, development of lactic acidosis in disease states is ominous, often indicating a critical illness of recent onset. Therefore, a careful history should be obtained to evaluate the underlying pathophysiologic cause of shock that contributed to lactic acidosis. Furthermore, a detailed history of ingestion of various prescription drugs or toxins from the patient or a collateral history from the patient's family should be obtained. The clinical signs and symptoms associated with lactic acidosis are highly dependent on the underlying etiology. No distinctive features are specific for hyperlactatemia. Lactate acidosis is present in patients who are critically ill from hypovolemic, septic, or cardiogenic shock. Lactate acidosis always should be suspected in the presence of elevated anion gap metabolic acidosis. Lactic acidosis is a serious complication of antiretroviral therapy. A history of antiretroviral treatment should be obtained. Children who have a relatively mild form of congenital lactic acidosis may develop firmament metabolic acidosis during an acute illness such as respiratory infection. These patients have a deficiency in the activity of pyruvate dehydrogenase, and the stress-induced increases in the glycolytic rate may result in severe metabolic acidosis. D-lactic acidosis, a unique form of lactic acidosis, can occur in patients with jejunoileal bypass or small bowel resection causing short bowel syndrome. In these settings, the glucose and car Continue reading >>

Lactic Acidosis Clinical Presentation

Lactic Acidosis Clinical Presentation

History The onset of acidosis may be rapid (ie, within minutes to hours) or progressive (ie, over a period of several days). Lactic acidosis frequently occurs during strenuous exercise in healthy people, bearing no consequence. However, development of lactic acidosis in disease states is ominous, often indicating a critical illness of recent onset. Therefore, a careful history should be obtained to evaluate the underlying pathophysiologic cause of shock that contributed to lactic acidosis. Furthermore, a detailed history of ingestion of various prescription drugs or toxins from the patient or a collateral history from the patient's family should be obtained. The clinical signs and symptoms associated with lactic acidosis are highly dependent on the underlying etiology. No distinctive features are specific for hyperlactatemia. Lactate acidosis is present in patients who are critically ill from hypovolemic, septic, or cardiogenic shock. Lactate acidosis always should be suspected in the presence of elevated anion gap metabolic acidosis. Lactic acidosis is a serious complication of antiretroviral therapy. A history of antiretroviral treatment should be obtained. Children who have a relatively mild form of congenital lactic acidosis may develop firmament metabolic acidosis during an acute illness such as respiratory infection. These patients have a deficiency in the activity of pyruvate dehydrogenase, and the stress-induced increases in the glycolytic rate may result in severe metabolic acidosis. D-lactic acidosis, a unique form of lactic acidosis, can occur in patients with jejunoileal bypass or small bowel resection causing short bowel syndrome. In these settings, the glucose and carbohydrates are metabolized in the colon into D-lactic acid, which is absorbed into systemi Continue reading >>

Does Metformin Cause Lactic Acidosis?

Does Metformin Cause Lactic Acidosis?

Lactic acidosis refers to the build up of the acid 'lactate' (also known as lactic acid) in the blood. We all produce lactic acid when breaking down sugar at times of stress and when we exercise vigorously. In some circumstances, too much lactic acid can build up in the blood. This happens particularly in situations where there is not enough oxygen in the blood, or the kidneys are not filtering out lactic acid as they should be. Examples of these situations are kidney failure, heart attacks and severe lung problems. If lactic acid builds up, this changes the pH of the blood and can be very dangerous. Although lactic acidosis is rare, it happens occasionally to very sick patients regardless of what medicines they are taking. Why might metformin increase the risk of lactic acidosis? In the 1970s, a medication called phenformin was removed from the market. This was because it was found to significantly increase the risk of lactic acidosis. Metformin is in the same family as phenformin (they are both biguanides), so as you can imagine, people wondered whether it might also increase the risk of lactic acidosis. What are the facts? In 50 years of using metformin there have been only 330 reported cases of lactic acidosis in people taking it. All the reported cases of lactic acidosis in people on metformin were in people who were extremely sick and might have had lactic acidosis due to their other problems, regardless of the fact that they were taking metformin. A large study (cochrane review) in 2010 found no cases of lactic acidosis in 347 trials reporting on people taking metformin (70,490 patient years of use). The same review found that lactic acid levels were the same in people whether they took metformin or not. What is the current thinking? The current thinking is that Continue reading >>

More in ketosis