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
- Decreased perfusion
- Drugs;
- Ethanol (methanol)
- Phenformin
- Fructose, sorbitol
- Ethanol (methanol)
- Congenital;
- Glucose-g-phosphatse deficiency
- Other inherited diseases with defective gluconeogenesis or pyruvate oxidation
- Glucose-g-phosphatse deficiency
- Tissue hyposia;
- 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
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