Nephrology Book


Blood Lactic Acid

Aka: Blood Lactic Acid, Lactic Acidosis, Lactic Acidosis Definition, Lactic Acid
  1. Physiology
    1. See Glucose Metabolism
  2. Causes: Tissue Hypoxia (Type A)
    1. Systemic hypoperfusion or shock
      1. Hypovolemia or Dehydration
      2. Cardiogenic Shock
      3. Septic Shock
      4. Seizure (transient)
    2. Local hypoperfusion
      1. Testicular Torsion
      2. Intestinal Volvulus
      3. Acute Mesenteric Ischemia
      4. Arterial embolism (e.g. Cerebrovascular Accident)
      5. Epinephrine infusion (causing tissue Hypoxia)
    3. Decreased arterial oxygen
      1. Hypoxemia (e.g. Asthma)
      2. Severe Anemia
      3. Carbon Monoxide Poisoning
  3. Causes: No tissue Hypoxia (Type B)
    1. Medical conditions (Type B1)
      1. Severe liver disease (related to Cori Cycle Lactic Acid generation)
      2. Cancer
      3. Thiamine deficiency
    2. Medications or toxins (Type B2, most are via mitochondrial cytopathy)
      1. Acetaminophen
      2. Cyanide
      3. Metformin
      4. Beta-2 Agonist (via increased pyruvate)
        1. Albuterol 10 mg neb increases Lactic Acid 0.8 mmoL/L
        2. Zitek (2016) Acad Emerg Med 23(6): 718-21 +PMID:26857949 [PubMed]
      5. Isoniazid (via liver toxicity)
      6. Tetracycline
      7. Linezolid
      8. Propofol
        1. Causes Propofol Infusion Syndrome
      9. Propylene gylcol (solvent for many parenteral drugs)
        1. Nitroglycerin
        2. Lorazepam
        3. Etomidate
        4. Phenytoin
      10. Nucleoside Reverse Transcriptase Inhibitor (NRTI agents)
        1. Zidovudine
        2. Lamivudine
        3. Didanosine
        4. Stavudine
      11. Toxic Alcohol ingestion
        1. Ethylene Glycol Poisoning
        2. Methanol Poisoning
    3. Congenital metabolic conditions (Type B3)
      1. Mitochondrial disorders
      2. Hypoglycemia
  4. Precations
    1. Lactic Acid is primarily used as a Sepsis marker and tissue ischemia marker (e.g. ischemic bowel)
      1. However, differential diagnosis of Lactic Acidosis is broad (see above)
      2. Avoid ordering Lactic Acid in low risk patients (non-toxic, previously healthy)
      3. Consider superimposed factors resulting in Lactic Acidosis (Asthma, Albuterol)
    2. Lactic Acid clearance outside Sepsis does not uniformly improve with Intravenous Fluids
      1. Cardiogenic Shock can also increase Lactic Acid and will worsen with excess fluids
      2. Outside Sepsis, Exercise caution in aggressive fluid Resuscitation to lower Lactic Acid
    3. References
      1. Herbert and Crager in Herbert (2018) EM:Rap 18(4): 1-3
  5. Efficacy: Children
    1. Lactic Acid has historically not been used in children, as much as it has become a mainstay in adult evaluation
    2. Lactic Acid may have more evidence for use in sick children (esp. Sepsis, Trauma) and their disposition
      1. Increased organ dysfunction in children with elevated Lactic Acid >4 mmol/L
        1. Scott (2012) Acad Emerg Med 19(11): 1276-80 +PMID: 23167859 [PubMed]
      2. Predicted need for Critical Care in children with Trauma and pre-hospital elevated Lactic Acid >4 mmol/L
        1. Shah (2013) Pediatr Emerg Care 29(6): 715-9 +PMID: 23714761 [PubMed]
      3. Predicted in-hospital mortality for critically ill children
        1. Bai (2014) BMC Pediatr 14:83 +PMID: 24673817 [PubMed]
  6. References
    1. (2013) Endo and Acid Base Disorders, EM Bootcamp, Las Vegas

Acidosis, Lactic (C0001125)

Definition (NCI) Metabolic acidosis characterized by the accumulation of lactate in the body. It is caused by tissue hypoxia.
Definition (MSH) Acidosis caused by accumulation of lactic acid more rapidly than it can be metabolized. It may occur spontaneously or in association with diseases such as DIABETES MELLITUS; LEUKEMIA; or LIVER FAILURE.
Definition (CSP) acidosis caused by accumulation of lactic acid more rapidly than it can be metabolized; may occur spontaneously or in association with diseases such as diabetes mellitus, leukemia, or liver failure.
Concepts Disease or Syndrome (T047)
MSH D000140
ICD10 E87.2
SnomedCT 91273001
English Acidosis, Lactic, Lactic Acidosis, ACIDOSIS LACTIC, lactic acidosis, lactic acidosis (diagnosis), Acidosis lactic, Acidosis, Lactic [Disease/Finding], lactacidosis, acidosis lactic, Lactic acidosis, Lactic acidosis (disorder)
French ACIDOSE LACTIQUE, Acidose lactique
Portuguese ACIDOSE LACTICA, Acidose láctica, Acidose Láctica
Spanish ACIDOSIS LACTICA, acidosis láctica (trastorno), acidosis láctica, Acidosis láctica, Acidosis Láctica
Dutch lactische acidose, melkzuur-acidose, Lactaatacidose
Swedish Mjölksyraacidos
Japanese ニュウサンアシドーシス, アシドーシス-乳酸, 乳酸アシドーシス, 乳酸性アシドーシス
Czech acidóza laktátová, Laktátová acidóza
Finnish Maitohappoasidoosi
German LAKTAZIDOSE, Laktatazidose, Azidose, Laktat-, Lactazidose
Polish Kwasica mleczanowa
Hungarian Lactat-acidosis, Lactat acidosis
Norwegian Laktacidose, Acidose, Laktat
Italian Acidosi lattica
Derived from the NIH UMLS (Unified Medical Language System)

Lactic acid (C0064582)

Definition (NCI_NCI-GLOSS) A substance made from sugars in milk, by the action of certain enzymes. It is used in skin care products to reduce wrinkles and soften the skin. It is also being studied in the treatment of hand-foot syndrome (a condition marked by pain, swelling, numbness, tingling, or redness of the hands or feet) in patients receiving chemotherapy. Lactic acid is also made in muscles in the body and is used in many chemical processes in the body. It is a type of alpha hydroxyl acid.
Definition (MSH) A normal intermediate in the fermentation (oxidation, metabolism) of sugar. The concentrated form is used internally to prevent gastrointestinal fermentation. (From Stedman, 26th ed)
Concepts Biologically Active Substance (T123) , Organic Chemical (T109) , Pharmacologic Substance (T121)
MSH D019344
SnomedCT 398659005, 77370004
English Lactic Acid, Lactic acid, wart therapeutic agents lactic acid (duofilm), lactic acid for treatment of warts (medication), lactic acid for treatment of warts, Lactic Acid [Chemical/Ingredient], LACTIC ACID, lactic acid, 2-Hydroxypropionic Acid, 2 Hydroxypropionic Acid, 2 Hydroxypropanoic Acid, 2-Hydroxypropanoic Acid, Lactic acid (product), Lactic acid (substance), Lactic acid, NOS
Swedish Mjölksyra
Czech kyselina mléčná
Finnish Maitohappo
Polish Mleczan, Kwas mlekowy
Spanish ácido láctico (producto), ácido láctico (sustancia), ácido láctico, Ácido Láctico
French Acide lactique
German Milchsäure
Italian Acido lattico
Portuguese Ácido Láctico
Derived from the NIH UMLS (Unified Medical Language System)

Blood lactic acid (C0853170)

Concepts Laboratory Procedure (T059)
Japanese 血中乳酸, ケッチュウニュウサン
Czech Kyselina mléčná v krvi
English Blood lactic acid, blood lactic acid, lactic acid blood
Italian Acido lattico ematico
Hungarian Tejsav vérszint
Portuguese Lactacidemia
Spanish Ácido láctico en sangre
Dutch bloed melkzuur
French Taux sanguin d'acide lactique
German Milchsaeure im Blut
Derived from the NIH UMLS (Unified Medical Language System)

Lactic acidosis (SMQ) (C1869036)

Definition (MDRCZE) Laktická acidóza je podobou metabolické acidózy s vysokou aniontovou mezerou Vlastní srdeční kontraktilita může být snížená, ale inotropická funkce může být normální kvůli uvolnění katecholaminu Může být přítomná periferní arteriální vazodilatace a centrální vazokonstrikce Funkce centrálního nervového systému je snížená, s bolestmi hlavy, letargií, stuporem a v některých případech dokonce i komatem Může dojít k intoleranci glukózy Je charakterizována zvýšením L-laktátu v plazmě Acidóza je zřídkakdy podstatná, pokud laktát v krvi nepřekročí 5 mmol/lKlinická manifestace u acidózy kyseliny mléčné typu B:Symptomy: hyperventilace nebo dyspnoe, stupor nebo kóma, zvracení, ospalost a bolesti břicha Nástup symptomů a příznaků je obvykle rychlý a provázený zhoršenou úrovní vědomí.
Definition (MDRJPN) 乳酸アシドーシスは高いアニオンギャップを伴う代謝性アシドーシスである。 内因性の心筋収縮能が抑制されると考えられるが、変力機能はカテコールアミンが放出されるため正常であることがある。 末梢動脈血管拡張および中枢性血管収縮が認められることがある。 中枢神経系機能は抑制され、頭痛、嗜眠、昏迷を伴うが、昏睡にまで至る場合もある。 グルコース不耐性が生じることがある。 血漿L-乳酸の増加を特徴とする。 血中乳酸値が5 mmol/Lを超過しない限りアシドーシスが著明化することは稀である。 タイプB乳酸アシドーシスの臨床症状は次のとおりである:症状:過換気または呼吸困難、昏迷または昏睡、嘔吐、傾眠、および腹痛。 徴候・症状の発症は通常急速で、意識レベルの悪化が伴う。
Definition (MDRHUN) A lactat acidosis a magas anion nyílású metabolikus acidosis egy formája Az intrinsic szívösszehúzódás depresszált lehet, de az inotrop funkció normális lehet a catecholamin felszabadulás miatt Perifériás artériás vasodilatatio és centrális vasoconstrictio lehet jelen A központi idegrendszer funkció depresszált, fejfájással, letargiával, kábultsággal és néhány esetben akár kómával. Glükóz intolerancia léphet fel. A plazmában bekövetkező L-lactat növekedés jellemzi. Az acidosis ritkán jelentős kivéve, ha a vér lactat túllépi a 5 mmol/l értéket. Klinikai prezentáció a B típusú lactat acidosisban: o Tünetek: hiperventilláció vagy dyspnea, kábultság vagy kóma, hányás, álmosság és hasi fájdalom o A tünetek és jelek kezdete általában gyors és az öntudat hanyatlásával társul.
Definition (MDR) Lactic acidosis is a form of high anion gap metabolic acidosis - Intrinsic cardiac contractility may be depressed, but inotropic function can be normal because of catecholamine release- Peripheral arterial vasodilatation and central vasoconstriction can be present - Central nervous system function is depressed, with headache, lethargy, stupor, and, in some cases, even coma - Glucose intolerance may occur - Characterized by an increase in plasma L-lactate - Acidosis is seldom significant unless blood lactate exceeds 5 mmol/l - Clinical presentation in type B lactic acidosis: o Symptoms: hyperventilation or dyspnea, stupor or coma, vomiting, drowsiness, and abdominal pain o Onset of symptoms and signs is usually rapid accompanied by deterioration in the level of consciousness.
Definition (MDRSPA) · La acidosis láctica es una forma de acidosis metabólica por desequilibrio aniónico · Podría haber depresión de la contractilidad cardiaca intrínseca, pero la función inotrópica puede ser normal debido a la liberación de catecolamina · La vasodilatación arterial periférica y la vasoconstricción central pueden estar presentes · Hay depresión de la función del SNC con cefalea, letargo, estupor y, en algunos casos, incluso coma · Puede producirse intolerancia a la glucosa · Está caracterizada por un aumento en el L-lactato sérico · La acidosis es rara vez importante a menos que el lactato en sangre sea superior a 5 mmol/l · Manifestación clínica en la acidosis láctica del tipo B: o Síntomas: hiperventilación o disnea, estupor o coma, vómitos, somnolencia y dolor abdominal o El comienzo de los síntomas y signos suele estar acompañado rápidamente por deterioro en el nivel de conciencia
Definition (MDRITA) L'acidosi lattica è una forma di acidosi metabolica da elevata deficienza anionica. La contrattilità cardiaca intrinseca potrebbe essere depressa, ma la funzione inotropica può essere normale a causa del rilascio di catecolamina. Possono verificarsi vasodilatazione arteriosa periferica e vasocostrizione centrale. La funzione del sistema nervoso centrale è depressa, con cefalea, letargia, stupore e in alcuni casi persino coma. Si potrebbe verificare intolleranza al glucosio. Caratterizzata da un aumento di L-lattato plasmatico. L'acidosi è raramente significativa purché il lattato ematico non ecceda 5 mmol/l. Presentazione clinica nell'acidosi lattica di tipo B: Sintomi: iperventilazione o dispnea, stupore o coma, vomito, sonnolenza e dolore addominale L'insorgenza dei sintomi e dei segni è generalmente rapida e accompagnata dal deterioramento del livello di coscienza
Definition (MDRFRE) · L'acidose lactique est une forme d'acidose métabolique à gap anionique élevé · La contractilité cardiaque intrinsèque peut être abaissée, mais la fonction inotropique peut être normale en raison de la libération de catécholamines · La vasodilatation artérielle périphérique et la vasoconstriction centrale peuvent être présentes · La fonction du système nerveux central est réduite, avec céphalées, léthargie, stupeur, voire dans certains cas, coma · Une intolérance au glucose peut se produire · Caractérisée par une élévation plasmatique du L-lactate · L'acidose est rarement significative à moins que le lactate sanguin ne dépasse 5 mmol/l · Présentation clinique d'acidose lactique de type B : o Symptômes : hyperventilation ou dyspnée, stupeur ou coma, vomissements, somnolence et douleurs abdominales o L'apparition de symptômes et signes est généralement rapide et s'accompagne d'une détérioration du niveau de conscience
Definition (MDRDUT) . Melkzuuracidose is een vorm van hoge anion-gap metabole acidose . De intrinsieke contractiliteit van het hart kan worden onderdrukt, maar de inotrope functie kan normaal zijn vanwege de vrijgave van catecholamine . Perifere arteriële vasodilatatie en centrale vasoconstrictie kunnen aanwezig zijn . De functie van het centraal zenuwstelsel is onderdrukt, met hoofdpijn, lethargie, stupor en, in sommige gevallen, zelfs coma . Er kan glucose-intolerantie optreden . Gekenschetst door een toename in plasma L-lactaat . Acidose is zelden significant tenzij het bloedlactaat meer dan 5 mmol/l bedraagt . Klinische presentatie in melkzuuracidose type B: o Symptomen: hyperventilatie of dyspneu, stupor of coma, braken, doezeligheid en buikpijn o Het optreden van symptomen en tekenen is gewoonlijk snel en gaat gepaard met verslechtering in de mate van bewustzijn
Definition (MDRGER) Laktatazidose ist eine Form metabolischer Azidose mit großer Anionenlücke Die intrinsische kardiale Kontraktilität kann deprimiert sein; jedoch kann die inotropische Funktion aufgrund der Katecholamin-Freisetzung normal sein. Periphere arterielle Vasodilatation und zentrale Vasokonstriktion kann bestehen. Die Funktion des Zentralnervensystems ist deprimiert; dies ist begleitet von Kopfschmerzen, Lethargie, Stupor und in einzelnen Fällen sogar von Koma. Glukoseintoleranz kann auftreten. Gekennzeichnet durch erhöhte L-Laktat-Werte im Plasma Azidose ist nur dann bedeutend, wenn der Laktatgehalt im Blut 5 mmol/l überschreitet Klinische Präsentation bei Typ B-Laktatazidose: o Symptome: Hyperventilation oder Atemnot, Stupor oder Koma, Erbrechen, Verschlafenheit und Bauchschmerzen o Symptome und Zeichen erscheinen gewöhnlich sehr schnell und sind von einer Verschlechterung des Bewusstseinszustands begleitet.
Definition (MDRPOR) • A acidose láctica é uma forma de acidose metabólica com uma lacuna de anião elevada • A contractilidade cardíaca intrínseca pode ser baixada, mas a função inotrópica pode ser normal devido à libertação de catecolaminas • A vasodilatação arterial periférica e a vasoconstrição central podem estar presentes • A função do sistema nervoso central está reduzida, com cefaleias, letargia, estupor, e, em certos casos, coma •Pode produzir-se uma intolerância à glucose • Caracterizada por uma elevação plasmática do L-lactato • A acidose, raramente, é significativa a menos que o lactato sanguíneo ultrapasse 5 mmol/l • Apresentação clínica de acidose láctica de tipo B: o Sintomas: hiperventilação ou dispneia, estupor ou coma, vómitos, sonolência e dores abdominais o A aparição de sintomas e de indícios é geralmente rápida e acompanhada de uma deterioração no nível da consciência
Concepts Classification (T185)
English Lactic acidosis (SMQ)
Dutch Melkzuuracidose (SMQ)
French Acidose lactique (SMQ)
German Laktatazidose (SMQ)
Italian Acidosi lattica (SMQ)
Portuguese Acidose láctica (SMQ)
Spanish Acidosis láctica (SMQ)
Czech Laktická acidóza (SMQ)
Japanese 乳酸アシドーシス(SMQ)
Hungarian Lactat acidosis (SMQ)
Derived from the NIH UMLS (Unified Medical Language System)

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