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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What Is A Lactic Acid Blood Test?
It’s a test that measures the amount of lactic acid (also called “lactate”) in your blood. This acid is made in muscle cells and red blood cells. It forms when your body turns food into energy. Your body relies on this energy when its oxygen levels are low. Oxygen levels might drop during an intense workout or when you have an infection or disease. Once you finish your workout or recover from the illness, your lactic acid level tends to go back to normal. But sometimes, it doesn't. Higher-than-normal lactic acid levels can lead to a condition called lactic acidosis. If it’s severe enough, it can upset your body’s pH balance, which indicates the level of acid in your blood. Lactic acidosis can lead to these symptoms: It’s a simple blood test. Your doctor will draw blood from a vein or artery using a needle. In rare cases, he may take a sample of cerebrospinal fluid from your spinal column during a procedure called a spinal tap. Normally, you don’t have to adjust your routine to prepare for the test. If your lactic acid level is normal, you don’t have lactic acidosis. Your cells are making enough oxygen. It also tells your doctor that something other than lactic acidosis is causing your symptoms. He’ll likely order other tests to find out what it is. If your lactic acid level is high, it could be caused by a number of things. Most often, it’s because you have a condition that makes it hard for you to breathe in enough oxygen. Some of these conditions could include: Severe lung disease or respiratory failure Fluid build-up in your lungs Very low red blood cell count (severe anemia) A higher-than-normal lactic acid level in your blood can also be a sign of problems with your metabolism. And, your body might need more oxygen than normal because you have o Continue reading >>
What Happens When Lactate Levels Are High?
What Happens When Lactate Levels Are High? Joseph Pritchard graduated from Our Lady of Fatima Medical School with a medical degree. He has spent almost a decade studying humanity. Dr. Pritchard writes as a San Francisco biology expert for a prominent website and thoroughly enjoys sharing the knowledge he has accumulated. Elevated lactate levels can affect your heart rhythm. Lactic acid is a by-product of the process cells use to produce energy. As cells convert glucose to energy, they use oxygen. If there is not enough oxygen within the cell, the cell is still able to produce energy, but also produces lactic acid. The cells releases lactic acid into the blood, where it is converted to a similar molecule called lactate. High lactate levels within the blood can harm your cells, the University of New Mexico warns. There are certain conditions that cause a decrease in oxygen levels and thus lactic acidosis. Severe hypoxia, such as in patients in shock, congestive heart failure, liver disease and lung disease are all possible causes of elevated lactate levels, according to MedlinePlus, a service of the National Institutes of Health. These diseases force the body to make energy without having enough oxygen. Elevated lactate levels can lead to severe complications. Lactic acidosis is a disorder that occurs when lactate levels in your bloodstream rise above the normal limits. Symptoms of this condition include an abnormal heartbeat, difficulty breathing, nausea, vomiting, muscle weakness, inflammation of the pancreas, fatigue, weight loss and enlargement of the liver, AidsHealth.org explains. If you experience these symptoms, immediately consult your doctor, as lactic acidosis is a potentially life-threatening condition. Measuring lactate levels requires a blood test called a Continue reading >>
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 >>
Increased Blood Lactate Levels: A Marker Of...?
Increased blood lactate levels: a marker of...? Increased blood lactate levels: a marker of...? Since Meakins in 1927 described the relationship between increased blood lactate levels and the presence of oxygen debt (tissue hypoxia) in patients with circulatory shock , lactate levels have been used to diagnose and monitor the treatment of these patients. However, as lactate is a normal (end) product of metabolism the relationship between increased lactate levels in patients and shock could be much more complicated. In the current paper we discuss the metabolism of lactate and its clinical implications. Lactate is a normal end product of glycolysis (Fig.1). It can only be formed from pyruvate mediated by lactatedehydrogenase . Under normal conditions this reaction results in alactate-to-pyruvate ratio of 10:1. All cells are capable ofproducing lactate. Tissues with a high metabolic rate (gut, brain,skeletal muscle) contribute largely to the daily lactateproduction. Normal blood lactate levels are 1.3 mmol/L . Lactatemetabolism mainly occurs in the liver and kidney. Lactate can onlybe metabolized by the conversion to pyruvate. Therefore, bloodlactate levels depend on pyruvate metabolism. The irreversibleconversion of pyruvate to Acetyl-CoA (mediated by pyruvatedehydrogenase) that is subsequently metabolized in the Krebs cycleresults in the production of adenosine triphosphate (ATP), carbondioxide and water. ATP can be seen as a universal energy sourcethat is required in many vital cellular functions. Pyruvate canalso be used to regenerate glucose by the conversion tooxaloacetate. In this way lactate can be converted back to glucosethat can subsequently be converted to lactate (Cori cycle).Regeneration of glucose from lactate is an important mechanism inrestoring Continue reading >>
Lactic Level: Order A Lactate Test For Online Results | Walk-in Lab
3-4 days. May take longer based on weather, holiday or lab delays. The Lactic Acid Plasma Test, or Lactate Test, measures the amount of lactate in the blood to determine if a patient has lactic acidosis. When cellular oxygen levels are lowduring intense exercise or when certain infections or diseases are presentthe body switches from aerobic energy production to anaerobic energy production to produce ATP (adenosine triphosphate), the body's primary energy source. Lactate is a byproduct of this process. When lactate is produced faster than the liver breaks it down, the resulting accumulation can develop into hyperlactatemia, which can then progress to lactic acidosis. Symptoms of lactic acidosis include muscle weakness, rapid breathing or shortness of breath, nausea, vomiting, sweating, abdominal pain, and in some cases, coma. Conditions that cause insufficient oxygen uptake in the lungs (type A) Reduced blood flow that decreases transport of oxygen to tissues (type A) Excess oxygen demand or metabolic problems (type B) Examples of conditions that can lead to type A lactic acidosis are sepsis, shock, heart attack, congestive heart failure, severe lung disease, respiratory failure, pulmonary edema, and severe anemia. Examples of conditions leading to type B lactic acidosis include strenuous exercise, liver or kidney disease, uncontrolled diabetes, leukemia, AIDS, glycogen storage diseases, and a variety of drugs and toxins. A Lactate Test will not diagnose the cause of excess lactate levels, but it can help determine if lactic acidosis is the cause of the patients symptoms. Other tests may be necessary to diagnose an underlying condition. The test may be ordered at prescribed intervals to monitor lactate levels. The Lactate Test is also known as Lactic Acid, Plasma Lacta Continue reading >>
A Simple Test For Urinary Lactic Acid
, Volume 6, Issue4 , pp 235238 | Cite as A new simple rapid test for the detection of increased urinary lactic acid is described. The method depends on the transformation of lactic acid to acetaldehyde by cesium IV. Acetaldehyde reacts with sodium nitroprusside producing a blue color. Patients from an emergency ward and patients with experimentally induced hyperlactatemia have been screened with this test. The results confirm that there exists a correlation between blood and urinary lactate levels and that a clinically relevant hyperlactatemia is associated with an increased urinary lactate concentration which can be reliably detected with this test. Lactic acidosisHyperlactataemiaUrinary lactic acid This is a preview of subscription content, log in to check access Unable to display preview. Download preview PDF. Alberti KGMM, Nattrass M (1977) Lactic acidosis Lancet II: 2529 Google Scholar Barker SB, Summerson WH (1941) Colorimetric determination of lactic acid in biological material. J Biol Chem 138:535554 Google Scholar Berger W, Mehnert-Aner S, Mlly K, Heierli Ch, Ritz R (1977) 10 Flle von Laktatazidose unter Biguanidtherapie (Buformin und Phenformin). Schweiz Med Wschr 106:18301834 Google Scholar Craig FN (1946) Renal tubular reabsorption, metabolic utilization and isomeric fractionation of lactic acid in the dog. Am J Physiol 146:1146159 Google Scholar Craig JW, Miller M, Woodward H, Merik E (1960) Influence of phenethylbiguanid on latic, pyruvic and citric acids in diabetic patients. Diabetes 9:186193 PubMed Google Scholar Hohorst HJ (1963) Methods of enzymatic analysis, pp 266270. Bergmeyer HU (ed) Acad. Press, New York Google Scholar Daalmans De Lange MM, Hommes FA (1974) The urinary lactate excretion in children. Helv Paediat Acta 29:599607 PubMed Google Scho Continue reading >>
Lactic Acidosis In Vivo: Testing The Link Between Lactate Generation And H+ Accumulation In Ischemic Mouse Muscle.
J Appl Physiol (1985). 2010 Jun;108(6):1479-86. doi: 10.1152/japplphysiol.01189.2009. Epub 2010 Feb 4. Lactic acidosis in vivo: testing the link between lactate generation and H+ accumulation in ischemic mouse muscle. Department of Radiology, Box 357115, University of Washington Medical Center, Seattle, WA 98195-7115, USA. The link between lactate generation and cellular acidosis has been questioned based on the possibility of H+ generation, independent of lactate production during glycolysis under physiological conditions. Here we test whether glycolytic H+ generation matches lactate production over a physiological pH and lactate range using ischemia applied to the hindlimb of a mouse. We measured the H+ generation and ATP level in vivo using 31P-magnetic resonance spectroscopy and chemically determined intracellular lactate level in the hindlimb muscles. No significant change was found in ATP content by chemical analysis (P>0.1), in agreement with the stoichiometric decline in phosphocreatine (20.2+/-1.2 mM) vs. rise in Pi (18.7+/-2.0 mM), as measured by 31P-magnetic resonance spectroscopy. A substantial drop in pH from 7.0 to 6.7 and lactate accumulation to 25 mM were found during 25 min of ischemia. The rise in H+ generation closely agreed with the accumulation of lactate, as shown by a close correlation with a slope near identity (0.98; r2=0.86). This agreement between glycolytic H+ production and elevation of lactate is confirmed by an analysis of the underlying reactions involved in glycolysis in vivo and supports the concept of lactic acidosis under conditions that substantially elevate lactate and drop pH. However, this link is expected to fail with conditions that deplete phosphocreatine, leading to net ATP hydrolysis and nonglycolytic H+ generation. Thus bot Continue reading >>
Acute Lactic Acidosis
Author: Bret A Nicks, MD, MHA; Chief Editor: Romesh Khardori, MD, PhD, FACP more... Metabolic acidosis is defined as a state of decreased systemic pH resulting from either a primary increase in hydrogen ion (H+) or a reduction in bicarbonate (HCO3-) concentrations. In the acute state, respiratory compensation of acidosis occurs by hyperventilation resulting in a relative reduction in PaCO2. Chronically, renal compensation occurs by means of reabsorption of HCO3. [ 1 , 2 ] Acidosis arises from an increased production of acids, a loss of alkali, or a decreased renal excretion of acids. The underlying etiology of metabolic acidosis is classically categorized into those that cause an elevated anion gap (AG) (see the Anion Gap calculator) and those that do not. Lactic acidosis, identified by a state of acidosis and an elevated plasma lactate concentration is one type of anion gap metabolic acidosis and may result from numerous conditions. [ 2 , 3 , 4 ] It remains the most common cause of metabolic acidosis in hospitalized patients. The normal blood lactate concentration in unstressed patients is0.5-1 mmol/L. Patients with critical illness can be considered to have normal lactate concentrations of less than 2 mmol/L. Hyperlactatemia is defined as a mild to moderate persistent increase in blood lactate concentration (2-4 mmol/L) without metabolic acidosis, whereas lactic acidosis is characterized by persistently increased blood lactate levels (usually >4-5 mmol/L) in association with metabolic acidosis. [ 1 , 5 ] Elevated lactate levels, while typically thought of as a marker of inadequate tissue perfusion with concurrent shift toward increased anaerobic metabolism, can be present in patients in whom systemic hypoperfusion is not present and therefore should be considered wit Continue reading >>
Lactic Acidosis Workup: Approach Considerations, Other Tests, Anion Gap
In many cases, the suggestion of lactic acidosis arises because of laboratory evidence of metabolic acidosis without an obvious etiology. Because the mortality rate of patients who develop lactic acidosis is high, prompt recognition and treatment of the underlying cause remain the only realistic hope for improving survival. Biochemical markers of impaired tissue perfusion may be useful, because they are indicative of end-organ failure, whereas hemodynamic patterns can vary in different patient groups. [ 13 , 14 ] Emerging technologies, such as noninvasive near-infrared spectroscopy, that look at the correlation between tissue perfusion and lactate levels, continue to be studied. At this time, several studies have identified good correlation with tissue perfusion and lactate clearance as markers of improved resuscitation and outcomes. [ 25 ] During the workup of a patient with metabolic acidosis, as indicated by low plasma bicarbonate and low pH on arterial blood gas (ABG) determinations (bicarbonate less than 22 mmol/L and pH less than 7.35), calculation of the serum anion gap may provide further clues to the etiology. The anion gap is the difference between measured cations and measured anions and is calculated by the following formula: Anion gap = sodium - (chloride + bicarbonate) The normal anion gap may vary depending on the laboratory, but it generally ranges from 8-12 mmol/L. Furthermore, the normal value for the anion gap must be adjusted in patients with hypoalbuminemia. Reduction in serum albumin by 10 g/L (1 g/dL) reduces the normal value for anion gap by 2.5 mmol/L. An elevated anion gap can be observed with renal failure and organic acidosis, such as lactic acidosis, ketoacidosis, and certain poisonings. However, clinically significant hyperlactatemia may o Continue reading >>
Hiv & Aids Information :: Factsheet Lactic Acidosis
Please enter the email address. Separate multiple addresses with a comma. Lactic acidosis refers to a build-up of lactic acid in the blood. It is a rare but dangerous side-effect of some anti-HIV drugs most of these are no longer in regular use. Your HIV clinic will use blood tests to check your levels of lactic acid. Lacticacidosis is very rare. Nevertheless, it is an important subject to understandbecause people who develop the condition can become dangerously ill. Lacticacidosis is a serious side-effect of the nucleosidereverse transcriptaseinhibitor (NRTI)class of anti-HIV drugs. This class includes abacavir (Ziagen),didanosine (ddI, Videx), lamivudine (3TC, Epivir), stavudine (d4T,Zerit), tenofovir (Viread) andzidovudine (AZT, Retrovir). The drugsmost linked with lactic acidosis are stavudine and didanosine. However, neitherof these drugs is now used if any other treatment options are available, mainlybecause of the side-effects they can cause. Lactic acidosis is also apotential, but rare, side-effect of other drugs, including the commonlyprescribed diabetes drug, metformin. The term lactic acidosis is used to describehigh levels of a substance called lactate in the blood. Lactate is a by-productof the processing of sugar within the body. Lacticacidosis is one of several conditions which are believed to be caused by damage to mitochondria . Mitochondriaare found in all human cells and are involved in the production of energy.Other possible side-effects ofNRTIs which may also be associated withdamage to mitochondria include peripheral neuropathy (numbness or pain in the feetand hands); bone marrow suppression; pancreatitis (inflammation of thepancreas); hepatic steatosis (accumulation of fat in the liver); and myopathy(muscle damage). "Lactic acidosis may occurat a Continue reading >>
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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 >>
004770: Lactic Acid, Plasma | Labcorp
Hypoperfusion is the most common cause of lactic acidosis and hyperlactacidemia may be the only marker of tissue hypoperfusion.1 Suspect lactic acidosis when unexplained anion gap metabolic acidosis is encountered, especially if azotemia or ketoacidosis are not present. Evaluate metabolic acidosis, regional or diffuse tissue hypoperfusion, hypoxia, shock,2 congestive heart failure, dehydration, complicated postoperative state, ketoacidosis or nonketotic acidosis in diabetes mellitus, patients with infections, inflammatory states, postictal state, certain myopathies, acute leukemia and other neoplasia, enzyme defects, glycogen storage disease (type I), thiamine deficiency, and hepatic failure. A spontaneous form of lactic acidosis occurs. It is a prognostic index in particular clinical settings, especially in critically ill patients in shock.3 A relationship to renal disease also exists. With skin rash, seizures, alopecia, ataxia, keratoconjunctivitis, and lactic acidosis in children, consider defective biotin metabolism.4 Phenformin, ethanol, methanol, and salicylate poisoning and ethylene glycol may cause lactic acidosis. Acetaminophen toxicity causes lactic acidosis, sometimes with hypoglycemia. Cyanide, isoniazid, and propylene glycol are among the causes of lactic acidosis.1 Lactic acidosis may be due to inborn errors of metabolism. Gross hemolysis elevates plasma results. Intravenous injections, or infusions which modify acid-base balance, may cause alterations in lactate levels. Epinephrine and exercise elevate lactate, as may IV sodium bicarbonate, glucose, or hyperventilation. False-low values may be found with a high LD (LDH) value. Specimen not separated from cells within 15 minutes of draw; marked hemolysis; slight or moderate turbidity; perchloric acid supe Continue reading >>
To detect high levels of lactate in the blood, which may be an indication of lack of oxygen ( hypoxia ) or the presence of other conditions that cause excess production or insufficient clearing of lactate from the blood; this test is not meant to be used for screening for health status. When you have symptoms such as rapid breathing, nausea, and sweating that suggest a lack of oxygen or an abnormal blood pH (acid/base imbalance); when a health practitioner suspects that you may be experiencing sepsis , shock, heart attack , severe congestive heart failure , kidney failure , or inadequately treated (uncontrolled) diabetes ; when a health practitioner suspects that you have inherited a rare metabolic or mitochondrial disorder A blood sample drawn from a vein in your arm; sometimes a blood sample collected from an artery and, rarely, a sample of cerebrospinal fluid collected from the spine You may be told to rest prior to sample collection. Rarely, fasting may be required. You may be able to find your test results on your laboratory's website or patient portal. However, you are currently at Lab Tests Online. You may have been directed here by your lab's website in order to provide you with background information about the test(s) you had performed.You will need to return to your lab's website or portal, or contact your healthcare practitionerin order to obtainyour test results. Lab Tests Online is an award-winning patient education website offering information on laboratory tests. The content on the site, which has been reviewed by laboratory scientists and other medical professionals,provides general explanations of what results might mean for each test listed on the site, such as what a high or low value might suggest to your healthcare practitionerabout your health or Continue reading >>
Dlac - Clinical: D-lactate, Plasma
An adjunct to urine D-lactate (preferred), in the diagnosis of D-lactate acidosis DLAU / D-Lactate, Urine is the preferred specimen for D-lactate determinations. Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test D-lactate is produced by bacteria residing in the colon when carbohydrates are not completely absorbed in the small intestine. When large amounts of D-lactate are present, individuals can experience metabolic acidosis, altered mental status (from drowsiness to coma), and a variety of other neurologic symptoms, particularly dysarthria and ataxia. D-lactic acidosis is typically observed in patients with a malabsorptive disorder, such as short-bowel syndrome, or, following a jejunoileal bypass. In addition, healthy children presenting with gastroenteritis may also develop the critical presentation of D-lactic acidosis. Routine lactic acid determinations in blood will not reveal abnormalities because most lactic acid assays measure only L-lactate. Accordingly, D-lactate analysis must be specifically requested (eg, DLAC / D-Lactate, Plasma). However, as D-lactate is readily excreted in urine, DLAU / D-Lactate, Urine is the preferred specimen for D-lactate determinations. Continue reading >>