Lactic Acidosis

What is Lactic Acidosis?

Lactic acidosis is a condition where lactic acid builds up in your bloodstream faster than your body can remove it. Lactic acid is a normal byproduct your cells produce when they break down glucose for energy. When your tissues don't get enough oxygen or your body can't clear lactic acid properly, levels rise too high.

Your blood normally has a specific pH balance. When lactic acid accumulates, it makes your blood more acidic than it should be. This disrupts normal cell function and can affect multiple organ systems. Mild cases may resolve on their own, but severe lactic acidosis is a medical emergency that requires immediate treatment.

The condition often signals that something else is wrong in your body. It can result from reduced blood flow, infections, certain medications, or metabolic problems. Understanding your lactic acid levels through blood testing helps identify problems early, before they become serious.

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Symptoms

Rapid or deep breathing
Nausea and vomiting
Abdominal pain or discomfort
Muscle weakness or fatigue
Confusion or difficulty thinking clearly
Fast heart rate
Sweet or fruity smelling breath
Feeling unusually tired or weak
Dizziness or lightheadedness
Loss of appetite

Some people with mild lactic acidosis may not notice symptoms right away. Early stages can be subtle and easily confused with other conditions. Symptoms often become more noticeable as acid levels continue to rise.

Causes and risk factors

Lactic acidosis happens when your cells produce too much lactic acid or your body cannot clear it fast enough. This often occurs when tissues don't receive enough oxygen, a state called hypoxia. Heart failure, severe infections like sepsis, and respiratory failure can all reduce oxygen delivery to tissues. Certain cancers increase lactic acid production as cancer cells use glucose differently than normal cells. Intense physical activity can temporarily raise lactic acid levels, though this usually resolves quickly in healthy people.

Several risk factors increase your chances of developing lactic acidosis. Taking metformin, a common diabetes medication, can trigger the condition in people with kidney disease or dehydration. Liver disease reduces your body's ability to clear lactic acid from your blood. Severe alcohol use, carbon monoxide poisoning, and certain genetic conditions also raise your risk. People with chronic conditions affecting the heart, lungs, or kidneys should monitor for signs of lactic acidosis regularly.

How it's diagnosed

Doctors diagnose lactic acidosis through blood tests that measure lactic acid levels and carbon dioxide. Normal lactic acid levels range from 0.5 to 2.2 millimoles per liter. Levels above 4 millimoles per liter typically confirm lactic acidosis. Carbon dioxide testing helps assess how severe the acid buildup is, since lactic acid consumes your body's bicarbonate buffer system. This causes CO2 levels to drop as your body tries to compensate for the acidity.

Rite Aid offers testing for both lactic acid and carbon dioxide as part of our comprehensive blood panel. These tests help identify lactic acidosis early and track how well treatment is working. Your doctor may order additional tests to find the underlying cause, such as kidney function tests, liver panels, or lactate measurements during exercise. Getting tested regularly is especially important if you take metformin or have conditions that increase your risk.

Treatment options

Treating the underlying cause, such as infections, heart failure, or medication issues
Oxygen therapy to improve tissue oxygen levels
Intravenous fluids to improve blood flow and help flush out lactic acid
Stopping medications that may contribute, especially metformin if kidney function is poor
Dialysis in severe cases to help remove acid from the blood
Sodium bicarbonate in specific situations to help neutralize acid
Managing diabetes carefully to prevent medication-related lactic acidosis
Staying well hydrated, especially during illness or intense exercise
Regular monitoring of kidney and liver function if you have risk factors
Avoiding excessive alcohol consumption

Frequently asked questions

Lactic acid levels above 4 millimoles per liter indicate lactic acidosis and require medical attention. Levels above 5 millimoles per liter are considered severe and can be life threatening. Normal levels range from 0.5 to 2.2 millimoles per liter. Even mildly elevated levels between 2 and 4 may signal an underlying problem that needs investigation.

Yes, metformin can cause lactic acidosis, though it's rare. This risk increases significantly in people with kidney disease, liver disease, or severe dehydration. Metformin-associated lactic acidosis happens when the drug builds up in your system because your kidneys can't clear it properly. If you take metformin, your doctor should check your kidney function regularly and adjust your dose if needed.

Lactic acidosis can develop over hours to days, depending on the cause. Sudden events like shock, severe infection, or heart attack can cause acid levels to rise within hours. Chronic conditions or medication buildup may take days or weeks to cause noticeable symptoms. This is why regular blood testing is important if you have risk factors.

No, lactic acidosis and ketoacidosis are different conditions, though both involve too much acid in the blood. Lactic acidosis results from excess lactic acid, while ketoacidosis comes from ketones building up. Ketoacidosis primarily affects people with diabetes, especially type 1. Both are serious and require prompt medical treatment, but they have different causes and treatments.

Intense exercise causes temporary lactic acid buildup in your muscles, but this rarely causes true lactic acidosis in healthy people. Your body quickly clears this lactic acid once you stop exercising. However, people with certain genetic disorders affecting metabolism may develop lactic acidosis during exercise. If you experience severe symptoms during or after workouts, talk to your doctor about testing.

Low carbon dioxide on a blood test often indicates metabolic acidosis, which includes lactic acidosis. When lactic acid builds up, it consumes your body's bicarbonate buffer, causing CO2 levels to drop. Your CO2 level helps doctors assess how severe the acid buildup is and whether your body is compensating properly. Low CO2 combined with high lactic acid confirms the diagnosis.

Hospital treatment focuses on correcting the underlying cause and supporting your body while it clears the acid. Doctors provide oxygen therapy, intravenous fluids, and medications to treat infections or heart problems. In severe cases, dialysis may be needed to remove acid from your blood. Treatment also includes stopping any medications that might be contributing, like metformin in people with kidney problems.

Many cases can be prevented by managing underlying health conditions carefully. If you take metformin, have your kidney function checked regularly and stay well hydrated. People with heart, lung, or liver disease should follow their treatment plans closely and report new symptoms promptly. Regular blood testing helps catch problems early before lactic acid reaches dangerous levels.

The long-term effects depend on how severe the episode was and what caused it. Mild cases that are treated quickly usually resolve without lasting damage. Severe lactic acidosis can damage organs, especially the brain, heart, and kidneys if not treated promptly. Some people may need ongoing monitoring and treatment for the underlying condition that triggered the acidosis.

Anyone taking metformin should have regular lactic acid monitoring, especially with kidney disease. People with heart failure, liver disease, cancer, or chronic lung conditions benefit from periodic testing. You should get tested if you experience symptoms like unexplained fatigue, rapid breathing, or confusion. Regular testing through a service like Rite Aid helps catch problems before they become emergencies.