leky-latky/laktat/zvyseni
Biguanides
- Class of blood glucose-lowering drugs used in the treatment of diabetes
- acutecaretesting.org/en/articles/lactate-and-lactic-acidosis/
Isoformy
- Lactic acid exists naturally in two isomeric forms: L-lactic acid and D-lactic acid.
- In humans lactate is derived from the L-form
- Some bacterial species can produce the D-form
- Can lead to abnormal increase in the gut of D-lactate-producing bacterial species
- Released to the gut, absorbed and accumulates in blood.
- Suffer episodes of D-lactic acidosis usually following ingestion of a high-carbohydrate meal
- Routine methods of lactate measurement detect only the L-isomer
- Blood lactate is falsely normal
- The only biochemical clue to the condition is unexplained high anion gap acidosis
- acutecaretesting.org/en/articles/lactate-and-lactic-acidosis/
Jejunoileal bypass surgery
- Treatment for severe obesity
- acutecaretesting.org/en/articles/lactate-and-lactic-acidosis/
Metformin
- The most widely prescribed, has been linked to lactic acidosis
- Most cases of metformin-associated lactic acidosis, there is some evidence of liver or renal impairment that predisposes to hyperlactatemia
- acutecaretesting.org/en/articles/lactate-and-lactic-acidosis/
Short-bowel syndrome
Symptoms
- Nausea and vomiting
- Muscle weakness
- Sweating
- Shortness of breath
- Abdominal pain
- journals.lww.com/nursingcriticalcare/fulltext/2009/09000/measuring_serum_lactate.13.aspx
- Serum lactate levels increase in:
- Lactic acidosis,
- Severe dehydration,
- Heart failure,
- Respiratory failure,
- Hemorrhage,
- Ketoacidosis,
- Severe infections,
- Alcohol abuse,
- Salicylate toxicity,
- Shock,
- Liver disease
- Anemia
- Lactic acid levels normally rise during strenuous exercise when perfusion can't meet the increased metabolic demands of skeletal muscles.
- journals.lww.com/nursingcriticalcare/fulltext/2009/09000/measuring_serum_lactate.13.aspx
Laktat zvýšený u DM
- Anion gap in a diabetic patient
- Especially if associated with evidence of compromised renal function
- Consider metformin as a contributing factor
- Especially important in patients with severe anion gaps associated with lactic acidosis
- Out of proportion to the patient's clinical presentation.
- Serum electrolytes
- Determination of acid-base status is beyond routine in today's clinical practice.
- Importance of recognizing and treating disturbances in normal physiology cannot be overstated
- Information can provide clues to the existence of many reversible
- If left untreated fatal, disease processes
- Most commonly used scenario for calculating the serum anion gap (AG) is determining the etiology of metabolic acidosis
- In a variety of conditions
Inherited deficiency of specific enzymes involved in lactate metabolism
- Congenital lactic acidosis
- Gluconeogenesis
- Pyruvate oxidation
Pyruvate carboxylase deficiency
Glucose-6-phosphate dehydrogenase (G6PD) deficiency
Fructose-1,6-diphosphatase deficiency
Pyruvate dehydrogenase deficiency
- The most common
- acutecaretesting.org/en/articles/lactate-and-lactic-acidosis/
In vitro glycolysis
- Lactate production continues after sampling
- Lactate concentration increases by 30 % in just 30 minutes if kept at room temperature
- For this reason blood must be analyzed immediately it is sampled.
- If there is to be any delay, the sample must be stored on ice to inhibit ongoing glycolysis.
- Preanalytical errors associated with lactate measurement are the subject of a recent review
- acutecaretesting.org/en/articles/lactate-and-lactic-acidosis/
Ethanol
- Metabolism of ethanol is associated with increased NADH/NAD+ ratio
- Favoring conversion of pyruvate to lactate
- Gluconeogenesis is also inhibited
- Combination of moderate hyperlactatemia and hypoglycemia is a not infrequent finding in patients suffering acute effects of alcohol abuse.
- Pre-existing alcoholic liver disease
- Exacerbates the acute hyperlactatemia-precipitating Type B lactic acidosis.
Methanol
Antiretroviral drugs
- Most HIV patients prescribed anti-retroviral drugs develop mild chronic hyperlactatemia
- (serum lactate 1.5-3.5 mmol/L)
- In a small unpredictable minority this evolves to severe lactic acidosis
- acutecaretesting.org/en/articles/lactate-and-lactic-acidosis/
Cyanide
- mitochondrial effect accounts for the lactic acidosis in cyanide poisoning.
- acutecaretesting.org/en/articles/lactate-and-lactic-acidosis/
Theophylline
Cocaine
Simvastatin
Salicylates
- Salicylate overdose can be associated with lactic acidosis
- Due to the inhibitory effect that salicylate has on oxidative phosphorylation.
- acutecaretesting.org/en/articles/lactate-and-lactic-acidosis/
Paracetamol (acetaminophen)
Lactulose
Propylene glycol
Epinephrine,
Norepinephrine
Metformin with intravascular iodinated contrast media
- For radiologic studies or procedures can cause lactic acidosis.
- Metformin should be discontinued in select patients (according to facility policy and procedure) at the time of the study or procedure and for 48 hours afterward.
- journals.lww.com/nursingcriticalcare/fulltext/2009/09000/measuring_serum_lactate.13.aspx
Prognostic value of lactate measurement in critical care
- Marker of inadequate tissue perfusion and tissue hypoxia in critical care
- Trauma victims and others suffering potential critical illness
- Lactate measurement has value in the emergency room and intensive care unit
- Blood lactate concentration predicts morbidity and mortality.
Prospective study of 76 major trauma victims
- Serial lactate measurements were made over the first 48 hours after admission
- All 27 patients whose lactate normalized within 24 hours survived
- Only three of 22 patients whose lactate remained raised at 48 hours survived.
Study of 1278 patients with infection
- Mortality was 4.9 % among those whose lactate was less than 2.5 mmol/L on admission
- Compared with 36 % among those whose lactate was over 4mmol/L
Early study of 233 critically ill patients various forms of shock
- Mortality rate of 67 % among those whose lactate was over 3.82 mmol/L
- Only 25 % for those whose lactate was <3.82 mmol/L
- Raised lactate in the context of trauma, sepsis and critical illness
- Generally is a poor prognostic sign
- Indicating the need for immediate and intensive resuscitative measures
- Point-of-care lactate testing
- Leads to improved outcomes for patients in a variety of critical care settings
Sepsis
- Condition in which the distinction between Type A and Type B lactic acidosis is inappropriate
- Lactate accumulates despite adequate tissue oxygenation
- Lactate accumulation in the absence of tissue hypoxia among patients with sepsis
- Reduced clearance of lactate from circulation by liver and kidneys
- Defect induced by sepsis in the enzyme pyruvate dehydrogenase
- Impairs pyruvate utilization in the citric acid cycle
- Increased pyruvate production
- Sepsis and septic shock are associated with a stress response
- Increased release of epinephrine (adrenalin)
- Stimulates the membrane-bound enzyme Na+/K+-ATPase
- Utilizes ATP generated by aerobic glycolysis to provide the energy necessary to "pump" ions into and out of cells
- Na+/K+-ATPase stimulation increases aerobic glycolysis and thereby lactate production.
- Hyperlactatemia associated with sepsis
- May be at least in part the result of this epinephrine-stimulated aerobic glycolysis
- Caused by or complicated by infection
- Lactic acidosis is not necessarily entirely the result of tissue hypoxia
- acutecaretesting.org/en/articles/lactate-and-lactic-acidosis/
Liver disease
Kidney disease
Diabetes that’s not under control
Leukemia
AIDS
