What are the causes of lactic acidosis

Lactic acidosis is actually a complication of diabetes. Once the disease occurs, the patient's chance of death is very high. It can cause liver and kidney dysfunction or even shock, as well as symptoms of hypotension, confusion and drowsiness. Common treatments include fluid replacement and alkali correction, or insulin supplementation. So what are the causes of lactic acidosis?

First, what are the causes of lactic acidosis? Most LA is acquired, and "congenital LA" caused by genetic defects (PDH, tricarboxylic acid cycle or respiratory chain defects) is very rare. The following discussion focuses on acquired LA. Common causes of acquired LA can be divided into the following two categories: tissue hypoxia (type A) and non-tissue hypoxia (type B). However, clinically, most LA are a mixture of type A and type B, involving the production and clearance of lactate and protons.

Second, type A ① tissue hypoperfusion: increased vascular permeability and abnormal tension; left ventricular failure, decreased cardiac output; hypotension shock; ② decreased arterial oxygen content: asphyxia; hypoxemia (PaO2<35 mmHg); carbon monoxide poisoning; severe anemia.

Third, preventive care. There are two main points to note in the prevention of diabetic lactic acidosis: ① For patients who need to be treated with biguanide hypoglycemic drugs, try to use the relatively safe metformin instead of phenformin (DBI); ② For patients with severe liver and kidney dysfunction, heart and lung dysfunction and shock, avoid using metformin or DBI.

What are the causes of lactic acidosis? Type B ① Common diseases: diabetes, sepsis, liver and kidney failure, cancer, malaria and cholera, etc.; ② Drugs or toxins: biguanides, ethanol, methanol, cyanide, nitroprusside, niacin, catecholamines, antipyretics, nalidixic acid, isoniazid, streptozotocin, sorbitol, parenteral nutrition, lactose, theophylline, cocaine, estrogen deficiency, etc.; ③ Genetic diseases: G-6 phosphate dehydrogenase deficiency, fructose 1,6-bisphosphatase deficiency, pyruvate carboxylase deficiency, pyruvate dehydrogenase deficiency and oxidative phosphorylation defect; ④ Other conditions: enhanced muscle movement and grand mal seizures. Diabetic lactic acidosis is type B.