Ian has an MBA and is a real estate investor, former health professions educator, and Air Force veteran.
Larry is a professional athlete who presents in the emergency room with severely low blood pressure and altered mental status. Given he was in the middle of an incredibly strenuous workout at the time he became ill, his healthcare team suspects lactic acidosis because his exercise program required him to enter an anaerobic workout state. Lactic acidosis is when lactate, the acidic byproduct of anaerobic respiration, builds up in the body, beyond the body's normal ability to buffer against such acids, and causes a blood pH imbalance. Lactic acidosis is commonly caused by intense physical exercise, but can also develop in cases of shock, kidney failure, vitamin deficiency, or when taking certain prescription drugs. With Larry's diagnosis certain, let's take a look at some of the treatment options that are available.
In any case of lactic acidosis, the goal is to treat the underlying cause of the condition. The healthcare team should consider the cause and evaluate if the issue could be solved by discontinuing a medication or making dietary changes. Different treatment methods are specifically tailored to solve different types of primary problems.
Aggressive Intravenous Hydration
If Larry doesn't already have an IV placed when he arrives at the hospital, he will have one placed as soon as possible. Rehydrating the patient with IV fluid replacement helps solve the low blood pressure problem increasing the total blood volume. The IV will also provide access to the bloodstream for other treatment options.
Sodium bicarbonate administered intravenously can help correct the acidic condition of the blood. Since sodium bicarbonate is alkaline in nature as opposed to acid, introduction of it into the body acts as a buffer to help neutralize the acid. This is a common method of treatment when a diabetic patient's lactic acidosis is due to alcohol consumption induced ketoacidosis. Fortunately for Larry, his case was relatively mild and rehydration along with sodium bicarbonate corrected his pH balance and resolved his problem.
Patients with a thiamine deficiency can be treated with vitamin B-1. Although thiamine deficiency is rare, B-1 is also commonly used to treat lactic acidosis patients where the cause is undetermined.
Hemodialysis is a useful treatment for lactic acidosis when a patient's condition is caused by kidney failure. It is also effective when the patient has had a reaction to the diabetes medication Metformin. Because lactic acid increases can be a symptom of kidney problems or failure, the dialysis machine filters the patient's blood as would a working kidney. When dialysis is combined with alkalinizing agents, the patient's buffering ability can be restored and correct the acid to alkaline balance of the blood.
Since lactic acidosis is often a symptom of some other underlying problem, the healthcare team should consider a specialist consultation in certain cases. Patients who need further additional testing may need to be seen by a critical care specialist. An endocrinologist may be able to help a patient who has chronic, mild excesses of lactic acid.
Lactic acidosis is when the buildup of lactic acid in the patient overwhelms the ability to buffer the acid, causing a blood pH imbalance. Since the condition is related to an underlying problem, the treatment method will depend on what is causing the increase in lactic acid production.
An IV will permit access to the blood stream to rehydrate the patient, and introduce other treatments. Alkalinizing agents such as sodium bicarbonate act as a buffer against the acid and help neutralize the blood pH. Thiamine deficiencies as well as unknown causes can be treated by giving the patient B-1 vitamins intravenously. Hemodialysis, also commonly known as just dialysis, combined with alkalinizing agents can be used to correct lactic acidosis when kidney failure is the problem by restoring the buffering capabilities of the body.
It may be worth asking for an appropriate specialist to give a consultation when certain underlying conditions are present. Critical care specialists can be helpful when the patient needs additional testing. Patients with chronic, moderate cases of lactic acidosis may benefit from seeing an endocrinologist.
Medical Disclaimer: The information on this site is for your information only and is not a substitute for professional medical advice.
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