From the Guidelines
Vomiting itself does not directly cause lactic acidosis, but it can contribute to conditions that lead to lactic acidosis, particularly through dehydration and compromised tissue perfusion, as noted in a study on managing diabetes in patients with COVID-19 1. Lactic acidosis occurs when there is an excess buildup of lactic acid in the bloodstream, typically due to inadequate oxygen delivery to tissues or impaired clearance of lactate. Severe or prolonged vomiting can lead to dehydration, electrolyte imbalances, and reduced blood volume, which may compromise tissue perfusion and oxygen delivery. This reduced perfusion can trigger anaerobic metabolism in cells, resulting in increased lactic acid production. Additionally, vomiting can cause hypovolemic shock in extreme cases, where decreased blood flow to tissues forces cells to produce energy without adequate oxygen, leading to lactic acid accumulation. Some studies discuss diabetic ketoacidosis, which involves the formation of β-hydroxybutyrate and accompanying acidosis, with symptoms including nausea and vomiting 1, but these do not directly address the relationship between vomiting and lactic acidosis. However, a more recent study emphasizes the importance of monitoring renal function during illness to prevent dehydration and lactic acidosis, especially in patients taking metformin 1. Key points to consider include:
- Dehydration and electrolyte imbalances can lead to lactic acidosis
- Vomiting may be a symptom of underlying conditions that cause lactic acidosis, such as sepsis or severe infections
- Monitoring renal function is crucial during illness to prevent complications
- Immediate medical attention is necessary for persistent vomiting accompanied by symptoms like rapid breathing, confusion, or extreme fatigue, as these could indicate developing acidosis requiring treatment with intravenous fluids, electrolyte replacement, and addressing the underlying cause.
From the Research
Lactic Acidosis and Vomiting
- Vomiting can be a symptom of lactic acidosis, as seen in a case report of metformin-associated lactic acidosis (MALA) where the patient presented with symptoms of malaise, dizziness, abdominal pain, nausea, and vomiting, along with signs of severe metabolic acidosis and elevated lactate levels 2.
- Lactic acidosis can occur due to various conditions, including metformin therapy, and its clinical presentation is often nonspecific, mimicking other conditions such as sepsis or gastrointestinal disorders 2, 3.
- The etiology of acute metabolic acidosis, which includes lactic acidosis, is heterogeneous and can be caused by conditions such as metformin therapy, unbalanced electrolyte preparations, and diabetic ketoacidosis 3.
Causes of Lactic Acidosis
- Metformin-associated lactic acidosis (MALA) is a rare but serious complication of metformin therapy, typically occurring in patients with underlying risk factors such as renal impairment 4, 2.
- Lactic acidosis can also occur due to other conditions, such as short bowel syndrome, which can lead to D-lactic acidosis, an uncommon and challenging form of metabolic acidosis 5.
- Unbalanced electrolyte preparations can induce hyperchloremic metabolic acidosis, which can worsen kidney-related outcome parameters 3.
Treatment of Lactic Acidosis
- Treatment of lactic acidosis involves discerning and correcting its underlying cause, ensuring adequate oxygen delivery to tissues, reducing oxygen demand through sedation and mechanical ventilation, and attempting to alkalinize the blood with IV sodium bicarbonate, although the use of bicarbonate is controversial 6.
- Continuous renal replacement therapy (CRRT) has been shown to be effective in treating MALA, with rapid control of metabolic acidosis and metformin elimination 4.
- Hemodialysis has also been used to treat MALA, with favorable outcomes in some cases 2.