Symptom >> Internal Medicine >> Endocrinology

Excessive accumulation of lactic acid

Introduction
Cause
Examine
Diagnosis

Introduction

Introduction Lactic acid is a product of the hypoxia metabolism of carbohydrates, and lactic acid production increases when tissue is hypoxic. For the human body, lactic acid is one of the fatigue substances, and is the waste generated by the body during the process of maintaining body temperature and body heat. Lactic acid accumulation is a chemical disorder in the body that can lead to fatal consequences. The higher the concentration of lactic acid, the lactic acidosis.

Cause

Cause

The occurrence of stress fatigue is mainly caused by the reaction of physiological conditions in the human body in the event of an emergency, which will produce a large amount of lactic acid and even form accumulation. If the exercise is too intense or long-lasting, or if the body lacks the vitamins and minerals necessary to break down the lactic acid, then the body's lactic acid can't be processed, causing the accumulation of lactic acid. Excessive lactic acid will make the weakly alkaline body fluid acidic, affecting the cells to absorb nutrients and oxygen smoothly, and weaken the normal function of the cells. The muscles that accumulate lactic acid contract, which squeezes the blood vessels, causing poor blood flow, resulting in muscle soreness, chills, headaches, and head sensation. Lactic acid accumulation causes soreness and burnout in the early stage. If it is left untreated for a long time, acidification of the body may cause serious diseases.

Tissue hypoperfusion caused by prolonged hypotension and decreased cardiac output can cause tissue hypoxia, increase anaerobic metabolism, and produce lactic acid accumulation. Congestion of the visceral and inferior vena cava system also causes hypoxia and increased lactic acid production in this part of the tissue. There is also a large amount of lactic acid accumulation in the gastrointestinal tract during hypoxia. After the inferior vena cava is opened, the blood flow back to the systemic circulation to aggravate lactic acidemia. In addition, the donor liver may also have lactic acid production and accumulation during low temperature and hypoxia during storage. The liver and kidneys are the main sites of lactic acid clearance, and the heart muscle is another major organ that eliminates lactic acid. In the absence of liver, due to the lack of lactic acid metabolism, and the lack of blood perfusion of the kidney, the metabolic capacity of lactic acid is reduced, which is bound to cause lactic acid accumulation.

Examine

an examination

Related inspection

Urine sugar blood sugar abdominal CT blood lactate

The key to establishing a diagnosis is to have a high degree of vigilance and sufficient cognitive ability in this disease. It is worth noting that lactic acidosis can sometimes be accompanied by ketoacidosis and hyperosmolar nonketotic hyperglycemic coma, thus increasing the diagnosis. Complexity In addition to acidosis caused by other causes such as uremia and salicylic acidosis.

In the shock state with acidosis, can be diagnosed as lactic acidosis without acid lactic acid poisoning, but in the case of acidosis with poor tissue perfusion, it is necessary to detect blood lactate levels in order to determine the diagnosis.

The main points of diagnosis of diabetic lactic acidosis are:

1. Have diabetes, but most patients have low blood sugar and no significant ketoacidosis.

2. The level of blood lactate is significantly increased, and more than 5mmol/L is the main basis for the diagnosis of lactic acidosis. The level of blood lactate is higher than normal (>1.8mmol/L). When it is 25mmol/L, it is mostly compensatory acidosis. Only those with high lactic acid and no acidosis can be diagnosed as hyperlactosis.

3. Evidence for acidosis such as pH < 7.35, blood bicarbonate < 20 mmol / L, anion gap > 18 mmol / L and so on. If the diagnosis of ketoacidosis and renal failure can be ruled out, combined with a significant increase in blood lactate levels, it can be confirmed as diabetic lactic acidosis.

Diagnosis

Differential diagnosis

1. Clinically, patients with coma, dehydration and acidosis, and shock, especially those with unexplained causes, ketone odor, low blood pressure and still high urine volume, should be alert to the possibility of lactic acidosis. Some have diabetes alone with DKA alone; some are complicated by coma caused by other diseases such as uremia, cerebrovascular accident, etc.; some may cause ketoacidosis after coma due to other diseases, etc., should be carefully identified . Generally, the medical history, physical examination, urine sugar, urinary ketone blood sugar, blood ketone and carbon dioxide binding blood gas analysis, etc., can be clearly diagnosed.

2. Identification of DKAHNDC and LA caused by acute metabolic disorder of diabetes and acute complication of diabetes mellitus with hypoglycemia.

The key to establishing a diagnosis is to have a high degree of vigilance and sufficient cognitive ability in this disease. It is worth noting that lactic acidosis can sometimes be accompanied by ketoacidosis and hyperosmolar nonketotic hyperglycemic coma, thus increasing the complexity of diagnosis. In addition, acidosis caused by other causes such as uremia and salicylic acidosis is required.