Lactic Acidosis Markers – Diagnosis and Significance
Lactic acidosis markers are diagnostic parameters measured in the blood that indicate dangerous over-acidification of the body due to elevated lactate levels. They are essential for early detection and monitoring of critical conditions.
Things worth knowing about "Lactic Acidosis Markers"
Lactic acidosis markers are diagnostic parameters measured in the blood that indicate dangerous over-acidification of the body due to elevated lactate levels. They are essential for early detection and monitoring of critical conditions.
What Are Lactic Acidosis Markers?
Lactic acidosis markers are laboratory and clinical parameters used to detect, diagnose, and monitor lactic acidosis – a serious metabolic disorder characterized by a drop in blood pH below 7.35 and an excessive accumulation of lactate (lactic acid) in the blood, typically above 5 mmol/l. This condition arises when the body´s cells are insufficiently supplied with oxygen and switch to anaerobic (oxygen-free) metabolism.
Key Lactic Acidosis Markers
Blood Lactate
The most important and direct marker is the blood lactate level. Normal values range from 0.5 to 2.0 mmol/l. Values between 2.0 and 5.0 mmol/l indicate hyperlactatemia (elevated lactate without pronounced acidosis), while values above 5.0 mmol/l combined with a low pH indicate manifest lactic acidosis. Measurement is performed on arterial or venous whole blood.
Blood pH
The blood pH value is a central parameter for assessing the acid-base balance. A pH below 7.35 indicates acidosis. In lactic acidosis, this value is often markedly reduced and reflects the severity of the metabolic disturbance.
Base Excess
The base excess (BE) indicates how much buffer base is missing or present compared to the normal state. In lactic acidosis, the BE is strongly negative (below –2 mmol/l), reflecting the exhaustion of the body´s buffering systems.
Bicarbonate (HCO₃⁻)
Bicarbonate is the most important blood buffer. In metabolic acidosis such as lactic acidosis, bicarbonate levels are reduced (below 22 mmol/l), as bicarbonate is consumed to neutralize excess acid.
Anion Gap
The anion gap is a calculated value that provides information about unmeasured anions in the blood. In lactic acidosis, the anion gap is elevated (normal: 8–12 mmol/l) because lactate, as an unmeasured anion, contributes to the gap. It helps distinguish different forms of metabolic acidosis from one another.
Lactate-to-Pyruvate Ratio
The lactate-to-pyruvate ratio provides insight into the underlying cause of elevated lactate. A ratio above 10 suggests impaired oxygen metabolism (e.g., due to oxygen deficiency or mitochondrial disease), while a normal ratio in the context of elevated lactate points to other causes.
Causes of Lactic Acidosis
Two main types are distinguished:
- Type A (hypoxic): Caused by oxygen deficiency in tissues, e.g., in shock, heart failure, severe blood loss, sepsis, or respiratory failure.
- Type B (non-hypoxic): Occurs without direct oxygen deficiency, e.g., in liver failure, certain medications (e.g., metformin, antiretroviral therapy), diabetes mellitus, malignancies, or inherited metabolic disorders.
Diagnosis
Lactic acidosis is diagnosed using an arterial or venous blood gas analysis (BGA) combined with lactate measurement. The BGA simultaneously provides pH, bicarbonate, and base excess values. Liver and kidney function tests, blood glucose, and if applicable, drug levels are additionally assessed to identify the underlying cause.
Clinical Significance and Treatment
Lactic acidosis markers are indispensable in intensive care medicine. Elevated lactate levels serve as an early warning sign of critical conditions and are associated with increased mortality. Treatment is directed at the underlying cause:
- Oxygen supply and circulatory stabilization in hypoxic lactic acidosis
- Discontinuation of causative medications in Type B lactic acidosis
- Bicarbonate administration in severe cases (subject to ongoing debate)
- Renal replacement therapy (dialysis) in severe renal failure or therapy-refractory acidosis
Regular monitoring of lactic acidosis markers enables the medical team to assess treatment success and adjust therapy accordingly.
References
- Kruse O, Grunnet N, Barfod C. Blood lactate as a predictor for in-hospital mortality in patients admitted acutely to hospital: a systematic review. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2011;19:74.
- Andersen LW et al. Etiology and therapeutic approach to elevated lactate levels. Mayo Clinic Proceedings. 2013;88(10):1127–1140.
- World Health Organization (WHO). Sepsis. Fact Sheet. 2020. Available at: https://www.who.int/news-room/fact-sheets/detail/sepsis
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