Lactic acidosis is a form of metabolic acidosis that occurs when there is excessive lactic acid production or impaired utilization, overwhelming the body's ability to regulate pH levels. It is responsible for metabolic acidosis in diabetics and may occur without ketosis. Treatment of the underlying condition is important, along with sodium bicarbonate therapy or renal replacement therapy like hemodialysis to remove lactate. Lactic acidosis can be caused by tissue hypoxia, liver failure, or certain drug effects like those of metformin in diabetics.

1. Lactic
Acidosis
in
Diabetes
PRESENTED BY
ANKIT
B.PHARM
4TH YEAR
GALGOTIAS
UNIVERSITY

2. What is Lactic acidosis
▪ Lactic acidosis is a form of metabolic acidosis that
begins when a person overproduces or
underutilizes lactic acid, and their body is not able
to adjust to these changes.
▪ Lactic acidosis is responsible for metabolic
acidosis in diabetics.
▪ It may occur in the presence of normal blood levels
of the ketone bodies, and such cases are often
described as having “non-ketotic diabetic acidosis.”

3. ▪ Lactic acid may contribute to the metabolic acidosis in
patients with true diabetic ketoacidosis, but the blood
lactate concentrations in these patients are not
usually very high.
▪ In some patients the ketoacidosis is replaced by a
lactic acidosis during treatment. This usually occurs in
association with a serious underlying disorder and is
associated with a poor prognosis(Disease symptom).
▪ A transient increase in blood lactate concentration
was in fact observed in most patients after the
beginning of treatment.

4. Diabetic Drug action
▪ Metformin is an oral antihyperglycemic agent used in the
management of type 2 diabetes mellitus.
▪ Metformin can cause potentially life-threatening
metabolic acidosis with an increased blood lactate level.
▪ The mechanism underlying the development of lactic
acidosis may involve the suppression of gluconeogenesis
from a number of substrates (e.g., glycerol, pyruvate,
lactate, and amino acids) leading to lactate accumulation.

5. Lactate metabolism in tissue
▪ Metabolized mainly by the liver (Cori cycle)
▪ All tissues can produce lactate under anaerobic
conditions

6. Causes of lactic acidosis
1) Type A (Hypoxia)
▪ Anemia
▪ Acute hypoxia
▪ Cardiogenic shock
2) Type B (Absence of hypotension)
▪ Liver failure
▪ Hereditary enzyme deficiency

7. Pathophysiology
▪ Lactic acidosis occurs whenever there is an imbalance
between the production and use of lactic acid.
▪ Causes of Lactic acidosis
1. Type A
2. Type B
3. D Lactic acidosis

8. Treatment of lactic acidosis
1. Treatment underlying disease
2. Sodium bicarbonate: may worsen oxygen
delivery, increase lactate production (especially
when hypoxia=>induce glycolysis), decrease
portal vein flow
3. Hemodialysis / CRRT (Continuous renal
replacement therapy)

9. References
▪ NCBI (Br Med J. 1969 Mar 22; 1{5646}: 744–
747)
▪ BMJ [Br Med
J 1969; 1 doi: https://doi.org/10.1136/bmj.1.56
46.744 (Published 22 March 1969)]
▪ Wikipedia