From the Guidelines
Crohn's disease itself does not directly cause lactic acidosis. Lactic acidosis is a condition characterized by excess lactic acid in the bloodstream, typically resulting from inadequate oxygen delivery to tissues or impaired lactate metabolism. While Crohn's disease is a chronic inflammatory bowel disease affecting the digestive tract, it doesn't inherently disrupt the metabolic processes that lead to lactic acid accumulation, as stated in the nice clinical guideline (cg152): the management of crohn's disease in adults, children and young people 1. However, severe complications of Crohn's disease such as intestinal obstruction, perforation, or severe infection could potentially lead to systemic issues including sepsis, which might secondarily cause lactic acidosis.
Some key points to consider in the management of Crohn's disease include:
- The approach to management needs to combine appropriate deployment of medical, surgical and/or endoscopic treatment with timely information and support, as outlined in the guideline 1.
- The aims of management include improving or completely resolving symptoms, improving or restoring quality of life, avoiding hospitalisation and promoting endoscopic mucosal healing whilst minimising adverse events, as stated in the guideline 1.
- Patients with Crohn's disease who develop symptoms like rapid breathing, confusion, or severe fatigue should seek immediate medical attention, as these could indicate metabolic complications requiring prompt treatment.
It is essential to note that some medications used to treat Crohn's disease may have adverse effects, but the guideline does not specifically mention lactic acidosis as a direct complication of Crohn's disease itself 1. Therefore, the primary focus should be on managing Crohn's disease and its complications, rather than worrying about lactic acidosis as a direct consequence of the disease.
From the Research
Lactic Acidosis and Chron's Disease
- There are no direct studies that suggest Chron's disease causes lactic acidosis 2, 3, 4, 5, 6.
- Lactic acidosis is a metabolic acidosis that can be caused by various factors, including metformin use, kidney and liver conditions, malignancy, or use of certain medications 2, 3, 6.
- Chron's disease is a type of inflammatory bowel disease that can cause abdominal symptoms, but its relationship to lactic acidosis is not well-established 5.
- Patients with Chron's disease may experience lactose intolerance, which can be objectified by hydrogen breath testing, but this is not directly related to lactic acidosis 5.
Metformin-Associated Lactic Acidosis
- Metformin-associated lactic acidosis (MALA) is a rare and potentially life-threatening complication of metformin use 2, 3, 6.
- MALA typically occurs in patients who are diabetic and also have other risk factors for lactic acidosis, including kidney and liver conditions, malignancy, or use of certain medications 3, 6.
- Prompt recognition and treatment of the underlying causes of lactic acidosis remain the cornerstone of treatment 4.