Lactic acidosis is a potentially life-threatening condition of excess lactic acid in the blood caused by low blood oxygen or hypoxia, which causes a low blood pH. A low blood pH means that the blood contains too much acid which can damage the cells in the body. Symptoms of lactic acidosis include nausea, vomiting, weakness, fatigue, shortness of breath, enlarged liver, cold or blue hands or feet, abnormal heart rate, and weight loss. Many conditions can cause hypoxia leading to lactic acidosis.
Sepsis
Sepsis is a life-threatening condition commonly caused by bacterial infections in the blood. The National Institutes of Health explains that when a person is septic, the body’s immune system overreacts, overwhelming normal processes in the blood. This leads to the formation of small blood clots that block blood flow from vital organs which can lead to organ failure, gangrene and lactic acidosis brought about by hypoxia. Clinical signs of sepsis include fever above 101.2, heart rate higher than 90, respirations higher than 20 breaths a minute and a probable or confirmed infection. When sepsis becomes severe skin becomes mottled, urine output decreases significantly, mental status changes occur and patients begin to have difficulty breathing, according to the Mayo Clinic. Treatment of sepsis includes doses of intravenous antibiotics, vasopressors to maintain blood pressure and low dose corticosteroids to control immune response. Once the sepsis is under control, lactic acidosis should subside.
HIV/AIDS
Patients with HIV or AIDS are at greater risk for developing lactic acidosis due to anti-viral medications called nucleotide reverse transcriptase inhibitors (NRTIs). Using NRTI’s such as stavudine and didanosine can cause an increase of lactate in the blood by disrupting the mitochondria, the cells that take in nutrients and break them down to create energy. This disruption of mitochondria is called mitochondrial toxicity. Mitochondrial toxicity can lead to damage in the heart, nerves, muscles, pancreas, kidneys and liver as well as causing lactic acidosis, low blood platelets, low red blood cells and fatty liver syndrome, according to the U.S. Department of Health and Human Services. Changes in medications can often help reverse the overproduction of lactate.
Metformin Hydrochloride
Metformin hydrochloride, also known as Glucophage, is an oral diabetes medication that helps control blood sugar in patients with Type 2 diabetes. People taking metformin hydrochloride have an increased risk for developing lactic acidosis, according to Food and Drug Administration (FDA). Patients who have any prior conditions that cause hypoxia such as congestive heart failure and elderly patients with decreased kidney function should not take metformin hydrochloride due to the increased likelihood that lactic acidosis may occur. Patients taking metformin hydrochloride should alert their physician immediately if the they begin to experience weakness, increased sleepiness, slow heart rate, cold feeling, muscle pain, shortness of breath, stomach pain, lightheadedness or fainting.
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