Table of ContentsView AllTable of ContentsTypesCausesSymptomsDiagnosisTreatmentOutlookPrevention
Table of ContentsView All
View All
Table of Contents
Types
Causes
Symptoms
Diagnosis
Treatment
Outlook
Prevention
This article explores lactic acidosis, including types, causes, symptoms, diagnosis, and treatment. It will also briefly review what a high lactate level means regarding potential medical outcomes.
Justin Paget / Getty Images
Acidosis: Understanding the Imbalance of Acids and Bases
Types of Lactic Acidosis
Lactic acidosis is a form ofmetabolic acidosis, a condition of excess acid in the bloodstream.
The two main types are:
What Causes Lactic Acidosis?
There are many causes of lactic acidosis, and sometimes the two types overlap.
Type A Lactic Acidosis
The infection that leads to septic shock can stem from within any organ, including the lungs (pneumonia), kidneys (urinary tract infection), or abdomen (e.g.,appendicitis).
Recognizing the Early Signs of Sepsis
Hypovolemic shockis another frequent cause of type A lactic acidosis. It develops due to a massive loss of blood or other bodily fluids.
Possible causes of hypovolemic shock include:
How Much Blood Is in the Human Body and How Much Can Be Lost?
Cardiogenic shock, which develops due to the heart malfunctioning, can also cause type A lactic acidosis. With cardiogenic shock, the heart fails to pump blood to vital organs. Aheart attackis the most common trigger for cardiogenic shock, accounting for 81% of cases.
How Many People Survive a Heart Attack?
Besides shock, other scenarios or conditions that can lead to type A lactic acidosis include:
Type B Lactic Acidosis
Causes of type B lactic acidosis include:
Who Is at Risk for Lactic Acidosis From Metformin?People most at risk for metformin-induced lactic acidosis are those with underlying kidney disease and other conditions that make them vulnerable to hypoperfusion (e.g., sepsis).
Who Is at Risk for Lactic Acidosis From Metformin?
People most at risk for metformin-induced lactic acidosis are those with underlying kidney disease and other conditions that make them vulnerable to hypoperfusion (e.g., sepsis).
Other drugs and toxins associated with type B lactic acidosis include:
What Are the Symptoms and Signs of Lactic Acidosis?
Symptoms and signs of lactic acidosis depend on the type, severity, and underlying cause.
Symptoms/signs ofseptic shockinclude:
Hypovolemic shocksymptoms and signs are similar to septic shock, although fever and warm skin are absent. Individuals with hypovolemic shock also have cool skin, dry eyes/mouth, and poorskin turgor(elasticity).
Symptoms/signs ofcardiogenic shockinclude:
Symptoms of type B lactic acidosis may include:
Other symptoms may be present depending on the underlying cause and severity of the acidosis.
For example, classic symptoms ofdiabetic ketoacidosisinclude:
Deeper Dive into Symptoms of Diabetic Ketoacidosis
How Lactic Acidosis Is Diagnosed
Lactic acidosis is diagnosed through three blood tests:
What Is a Normal Lactate Level?A normal lactate level is between 0.5 and 1.8 millimoles per liter (mmol/L). An elevated lactate is between 2 and 5 mmol/L, whereas a severely elevated lactate level is greater than 5 mmol/L.
What Is a Normal Lactate Level?
A normal lactate level is between 0.5 and 1.8 millimoles per liter (mmol/L). An elevated lactate is between 2 and 5 mmol/L, whereas a severely elevated lactate level is greater than 5 mmol/L.
Understanding pH Balance in the Body
How Lactic Acidosis Is Treated
Sorting out the type and cause of lactic acidosis is key to guiding treatment.
The treatment of type A lactic acidosis aims to improve oxygen availability and correct the underlying cause (e.g., infection, blood or fluid loss, or the heart’s poor pumping ability).
These interventions are performed in an intensive care unit (ICU) or coronary care unit (CCU) and may include:
Keep in mind that temporary causes of type A lactic acidosis, namely overexercising, are usually treated at home with rest and fluids. In such cases, a person’s liver and (to a lesser degree) kidneys eventually clear the lactate from the bloodstream.
The treatment of type B lactic acidosis is geared towards the specific cause.
Examples of such interventions include:
Overview of Cancer Treatments
What’s the Outlook for Lactic Acidosis?
The greater the lactate level in hospitalized individuals with lactic acidosis, the higher the risk of death.As such, lactate levels are a marker ofprognosis(disease outcome).
More specifically, since an increased lactate level can predict severe outcomes, including death, it’s essential to obtain a blood lactate test early on when a person with a critical illness enters the emergency room or hospital.
In addition, blood lactate levels should be tracked (if elevated) and used as a resource when choosing therapies to optimize chances for a full recovery.
How to Prevent Lactic Acidosis
While there is no foolproof strategy to prevent lactic acidosis,practicing healthy lifestyle behaviorscan help maintain the integrity of your liver and kidneys, which are crucial for lactate clearance. Moreover, a healthy lifestyle may help prevent specific underlying causes of lactic acidosis, like infection or cancer.
Such behaviors include:
Lastly, if you have a disease or are taking a medication that may cause lactic acidosis, please contact your healthcare provider for new or worrisome symptoms.
Summary
Lactic acidosis has multiple causes, including shock. Types of shock include septic (widespread infection), hypovolemic (loss of blood/fluid), and cardiogenic (heart malfunctioning) shock.
Excessive exercise is another cause of lactic acidosis. Unlike shock, though, which requires intensive hospital care, lactic acidosis from overexercising is not dangerous and resolves quickly with rest and hydration. Certain medications, liver disease, cancer, and HIV/AIDS, among many others, can also cause lactic acidosis.
Regarding a diagnosis, lactic acidosis requires blood tests that measure the lactate level and evaluate for acidity in the bloodstream. Treatment depends on the underlying cause and other factors, such as disease severity.
If you have concerns about developing lactic acidosis, speak with a healthcare provider. Early attention and treatment are key to managing this complex condition.
If you or a loved one has recently recovered from a serious illness associated with lactic acidosis, take time to review the next steps with your healthcare team carefully.
13 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Seheult J, Fitzpatrick G, Boran G.Lactic acidosis: an update.Clin Chem Lab Med. 2017;55(3):322-333. doi:10.1515/cclm-2016-0438Basodan N, Al Mehmadi AE, Al Mehmadi AE, et al.Septic shock: management and outcomes.Cureus. 2022;14(12):e32158. doi:10.7759/cureus.32158Standl T, Annecke T, Cascorbi I, Heller AR, Sabashnikov A, Teske W.The nomenclature, definition and distinction of types of shock.Dtsch Arztebl Int. 2018;115(45):757-768. doi:10.3238/arztebl.2018.0757Vahdatpour C, Collins D, Goldberg S.Cardiogenic shock.J Am Heart Assoc. 2019;8(8):e011991. doi:10.1161/JAHA.119.011991Alessandri F, Badenes R, Bilotta F.Seizures and sepsis: a narrative review.J Clin Med. 2021;10(5):1041. doi:10.3390/jcm10051041Villar J, Short JH, Lighthall G.Lactate predicts both short- and long-term mortality in patients with and without sepsis.Infect Dis (Auckl). 2019;12:1178633719862776. doi:10.1177/1178633719862776Agedal KJ, Steidl KE, Burgess JL.An overview of type B lactic acidosis due to thiamine (B1) deficiency.J Pediatr Pharmacol Ther. 2023;28(5):397-408. doi:10.5863/1551-6776-28.5.397Feenstra RA, Kiewiet MK, Boerma EC, ter Avest E.Lactic acidosis in diabetic ketoacidosis.BMJ Case Rep. 2014;2014:bcr2014203594. doi:10.1136/bcr-2014-203594Oseguera M, Yau AA.Lactic acidosis in a patient with cancer.Clin Med (Lond). 2023;23(6):615-617. doi:10.7861/clinmed.2023-0391DeFronzo R, Fleming GA, Chen K, Bicsak TA.Metformin-associated lactic acidosis: current perspectives on causes and risk.Metabolism. 2016;65(2):20-29. doi:10.1016/j.metabol.2015.10.014Shahid W, Khan F, Makda A, Kumar V, Memon S, Rizwan A.Diabetic ketoacidosis: clinical characteristics and precipitating factors.Cureus. 2020;12(10):e10792. doi:10.7759/cureus.10792Adeva-Andany MM, Fernández-Fernández C, Mouriño-Bayolo D, Castro-Quintela E, Domínguez-Montero A.Sodium bicarbonate therapy in patients with metabolic acidosis.ScientificWorldJournal. 2014;2014:627673. doi:10.1155/2014/627673Alshiakh SM.Role of serum lactate as prognostic marker of mortality among emergency department patients with multiple conditions: a systematic review.SAGE Open Med. 2023;11:20503121221136401. doi:10.1177/20503121221136401
13 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Seheult J, Fitzpatrick G, Boran G.Lactic acidosis: an update.Clin Chem Lab Med. 2017;55(3):322-333. doi:10.1515/cclm-2016-0438Basodan N, Al Mehmadi AE, Al Mehmadi AE, et al.Septic shock: management and outcomes.Cureus. 2022;14(12):e32158. doi:10.7759/cureus.32158Standl T, Annecke T, Cascorbi I, Heller AR, Sabashnikov A, Teske W.The nomenclature, definition and distinction of types of shock.Dtsch Arztebl Int. 2018;115(45):757-768. doi:10.3238/arztebl.2018.0757Vahdatpour C, Collins D, Goldberg S.Cardiogenic shock.J Am Heart Assoc. 2019;8(8):e011991. doi:10.1161/JAHA.119.011991Alessandri F, Badenes R, Bilotta F.Seizures and sepsis: a narrative review.J Clin Med. 2021;10(5):1041. doi:10.3390/jcm10051041Villar J, Short JH, Lighthall G.Lactate predicts both short- and long-term mortality in patients with and without sepsis.Infect Dis (Auckl). 2019;12:1178633719862776. doi:10.1177/1178633719862776Agedal KJ, Steidl KE, Burgess JL.An overview of type B lactic acidosis due to thiamine (B1) deficiency.J Pediatr Pharmacol Ther. 2023;28(5):397-408. doi:10.5863/1551-6776-28.5.397Feenstra RA, Kiewiet MK, Boerma EC, ter Avest E.Lactic acidosis in diabetic ketoacidosis.BMJ Case Rep. 2014;2014:bcr2014203594. doi:10.1136/bcr-2014-203594Oseguera M, Yau AA.Lactic acidosis in a patient with cancer.Clin Med (Lond). 2023;23(6):615-617. doi:10.7861/clinmed.2023-0391DeFronzo R, Fleming GA, Chen K, Bicsak TA.Metformin-associated lactic acidosis: current perspectives on causes and risk.Metabolism. 2016;65(2):20-29. doi:10.1016/j.metabol.2015.10.014Shahid W, Khan F, Makda A, Kumar V, Memon S, Rizwan A.Diabetic ketoacidosis: clinical characteristics and precipitating factors.Cureus. 2020;12(10):e10792. doi:10.7759/cureus.10792Adeva-Andany MM, Fernández-Fernández C, Mouriño-Bayolo D, Castro-Quintela E, Domínguez-Montero A.Sodium bicarbonate therapy in patients with metabolic acidosis.ScientificWorldJournal. 2014;2014:627673. doi:10.1155/2014/627673Alshiakh SM.Role of serum lactate as prognostic marker of mortality among emergency department patients with multiple conditions: a systematic review.SAGE Open Med. 2023;11:20503121221136401. doi:10.1177/20503121221136401
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Seheult J, Fitzpatrick G, Boran G.Lactic acidosis: an update.Clin Chem Lab Med. 2017;55(3):322-333. doi:10.1515/cclm-2016-0438Basodan N, Al Mehmadi AE, Al Mehmadi AE, et al.Septic shock: management and outcomes.Cureus. 2022;14(12):e32158. doi:10.7759/cureus.32158Standl T, Annecke T, Cascorbi I, Heller AR, Sabashnikov A, Teske W.The nomenclature, definition and distinction of types of shock.Dtsch Arztebl Int. 2018;115(45):757-768. doi:10.3238/arztebl.2018.0757Vahdatpour C, Collins D, Goldberg S.Cardiogenic shock.J Am Heart Assoc. 2019;8(8):e011991. doi:10.1161/JAHA.119.011991Alessandri F, Badenes R, Bilotta F.Seizures and sepsis: a narrative review.J Clin Med. 2021;10(5):1041. doi:10.3390/jcm10051041Villar J, Short JH, Lighthall G.Lactate predicts both short- and long-term mortality in patients with and without sepsis.Infect Dis (Auckl). 2019;12:1178633719862776. doi:10.1177/1178633719862776Agedal KJ, Steidl KE, Burgess JL.An overview of type B lactic acidosis due to thiamine (B1) deficiency.J Pediatr Pharmacol Ther. 2023;28(5):397-408. doi:10.5863/1551-6776-28.5.397Feenstra RA, Kiewiet MK, Boerma EC, ter Avest E.Lactic acidosis in diabetic ketoacidosis.BMJ Case Rep. 2014;2014:bcr2014203594. doi:10.1136/bcr-2014-203594Oseguera M, Yau AA.Lactic acidosis in a patient with cancer.Clin Med (Lond). 2023;23(6):615-617. doi:10.7861/clinmed.2023-0391DeFronzo R, Fleming GA, Chen K, Bicsak TA.Metformin-associated lactic acidosis: current perspectives on causes and risk.Metabolism. 2016;65(2):20-29. doi:10.1016/j.metabol.2015.10.014Shahid W, Khan F, Makda A, Kumar V, Memon S, Rizwan A.Diabetic ketoacidosis: clinical characteristics and precipitating factors.Cureus. 2020;12(10):e10792. doi:10.7759/cureus.10792Adeva-Andany MM, Fernández-Fernández C, Mouriño-Bayolo D, Castro-Quintela E, Domínguez-Montero A.Sodium bicarbonate therapy in patients with metabolic acidosis.ScientificWorldJournal. 2014;2014:627673. doi:10.1155/2014/627673Alshiakh SM.Role of serum lactate as prognostic marker of mortality among emergency department patients with multiple conditions: a systematic review.SAGE Open Med. 2023;11:20503121221136401. doi:10.1177/20503121221136401
Seheult J, Fitzpatrick G, Boran G.Lactic acidosis: an update.Clin Chem Lab Med. 2017;55(3):322-333. doi:10.1515/cclm-2016-0438
Basodan N, Al Mehmadi AE, Al Mehmadi AE, et al.Septic shock: management and outcomes.Cureus. 2022;14(12):e32158. doi:10.7759/cureus.32158
Standl T, Annecke T, Cascorbi I, Heller AR, Sabashnikov A, Teske W.The nomenclature, definition and distinction of types of shock.Dtsch Arztebl Int. 2018;115(45):757-768. doi:10.3238/arztebl.2018.0757
Vahdatpour C, Collins D, Goldberg S.Cardiogenic shock.J Am Heart Assoc. 2019;8(8):e011991. doi:10.1161/JAHA.119.011991
Alessandri F, Badenes R, Bilotta F.Seizures and sepsis: a narrative review.J Clin Med. 2021;10(5):1041. doi:10.3390/jcm10051041
Villar J, Short JH, Lighthall G.Lactate predicts both short- and long-term mortality in patients with and without sepsis.Infect Dis (Auckl). 2019;12:1178633719862776. doi:10.1177/1178633719862776
Agedal KJ, Steidl KE, Burgess JL.An overview of type B lactic acidosis due to thiamine (B1) deficiency.J Pediatr Pharmacol Ther. 2023;28(5):397-408. doi:10.5863/1551-6776-28.5.397
Feenstra RA, Kiewiet MK, Boerma EC, ter Avest E.Lactic acidosis in diabetic ketoacidosis.BMJ Case Rep. 2014;2014:bcr2014203594. doi:10.1136/bcr-2014-203594
Oseguera M, Yau AA.Lactic acidosis in a patient with cancer.Clin Med (Lond). 2023;23(6):615-617. doi:10.7861/clinmed.2023-0391
DeFronzo R, Fleming GA, Chen K, Bicsak TA.Metformin-associated lactic acidosis: current perspectives on causes and risk.Metabolism. 2016;65(2):20-29. doi:10.1016/j.metabol.2015.10.014
Shahid W, Khan F, Makda A, Kumar V, Memon S, Rizwan A.Diabetic ketoacidosis: clinical characteristics and precipitating factors.Cureus. 2020;12(10):e10792. doi:10.7759/cureus.10792
Adeva-Andany MM, Fernández-Fernández C, Mouriño-Bayolo D, Castro-Quintela E, Domínguez-Montero A.Sodium bicarbonate therapy in patients with metabolic acidosis.ScientificWorldJournal. 2014;2014:627673. doi:10.1155/2014/627673
Alshiakh SM.Role of serum lactate as prognostic marker of mortality among emergency department patients with multiple conditions: a systematic review.SAGE Open Med. 2023;11:20503121221136401. doi:10.1177/20503121221136401
Meet Our Medical Expert Board
Share Feedback
Was this page helpful?Thanks for your feedback!What is your feedback?OtherHelpfulReport an ErrorSubmit
Was this page helpful?
Thanks for your feedback!
What is your feedback?OtherHelpfulReport an ErrorSubmit
What is your feedback?
