My Clinical Notes

• Lactic acid is a normal metabolite of muscle and is converted back to glucose by the liver (the Cori cycle)
• However with increase production and possibly impairment of hepatic metabolism due to poor perfusion, it can accumulate
• Poor renal function can also lead to less H+ ions being excreted
• May occur in diabetic patients on biguanide therapy e.g. metformin
• These drugs inhibit the Kreb’s cycle and gluconeogenesis
• Risk is low provided that the therapeutic does is not exceeded and the drug is withheld in patients with hepatic or renal dysfunction
• Nowadays associated with;
  • Tissue hyposia;
    • Decreased perfusion
    • Reduced arterial PO2
  • Drugs;
    • Ethanol (methanol)
    • Phenformin
    • Fructose, sorbitol
  • Congenital;
    • Glucose-g-phosphatse deficiency
    • Other inherited diseases with defective gluconeogenesis or pyruvate oxidation
• Lactate acidosis can be suspected if the plasma bicarbonate concentration is very low in the absence of another obvious cause of metabolic acidosis. The anion gap is increased

This entry was posted on Saturday, October 13th, 2007 at 4:58 am and is filed under Diabetes. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.