Can alcohol (ethanol) abuse cause elevated lactic acid levels, also known as lactic acidosis?

From the Guidelines

Alcohol abuse can indeed cause elevated lactic acid levels in the blood, leading to a condition known as lactic acidosis, primarily through the impairment of liver function and alteration of metabolic pathways, as supported by the most recent and highest quality study available 1.

Mechanisms of Lactic Acidosis in Alcohol Abuse

The relationship between alcohol consumption and lactic acidosis is multifaceted:

• Alcohol metabolism in the liver increases the ratio of NADH to NAD+, promoting the conversion of pyruvate to lactate.
• Chronic alcohol use impairs liver function, reducing its ability to clear lactate from the bloodstream.
• Alcohol-induced conditions such as thiamine deficiency, malnutrition, and compromised tissue oxygenation can further increase lactate production.

Clinical Implications and Treatment

In severe cases, particularly during alcohol withdrawal or in alcoholic ketoacidosis, lactic acid levels can rise significantly, leading to symptoms such as nausea, vomiting, abdominal pain, rapid breathing, confusion, and in extreme cases, shock.

Key Considerations

• The risk of liver fibrosis and other complications from alcohol abuse is influenced by factors such as binge drinking patterns, gender, ethnicity, and the presence of other health conditions like obesity and hepatitis virus infections, as highlighted in the study 1.
• Treatment involves addressing the underlying alcohol abuse, providing supportive care, and correcting nutritional deficiencies, particularly thiamine supplementation to prevent Wernicke-Korsakoff syndrome.
• The study from the Journal of Hepatology in 2018 1 emphasizes the importance of considering these factors in the management of alcohol-related liver disease, underscoring the need for a comprehensive approach to patient care.

From the Research

Alcohol Abuse and Elevated Lactic Acid

• Alcohol abuse can cause elevated lactic acid, as evidenced by several studies 2, 3, 4, 5, 6.
• Metabolic acidosis due to lactic acidosis, ketoacidosis, and acetic acidosis can occur in patients with alcohol-induced acidosis 2.
• Lactic acidosis is a common complication of alcohol abuse, and it can be caused by the "overproduction" of NADH in the liver 2.
• A study found that significant elevations of blood lactate are uncommon in acute ethanol intoxication, but other potential causes for lactic acidosis should be considered 3.
• Alcoholic ketoacidosis and lactic acidosis are metabolic disorders that can occur in alcoholics after an episode of binge drinking and subsequent abrupt termination of alcohol and food consumption 4.
• Lactate metabolism and lactic acidosis can be affected by various factors, including tissue hypoxia, alkalosis, catecholamine, and alanine transamination to pyruvate 5.
• Alcohol abuse is a common cause of lactic acidosis associated with diabetes mellitus, and treatment of lactic acidosis consists of alkalization, insulin-glucose-infusion, and other therapies 5.
• The prognosis of alcohol-associated lactic acidosis in critically ill patients is generally good, with a mortality rate of 8.7% in one study 6.

Key Findings

• Elevated lactic acid can be caused by alcohol abuse 2, 3, 4, 5, 6.
• Lactic acidosis is a common complication of alcohol abuse 2, 3, 4, 5, 6.
• Treatment of lactic acidosis consists of alkalization, insulin-glucose-infusion, and other therapies 5.
• The prognosis of alcohol-associated lactic acidosis in critically ill patients is generally good 6.

Study Results

• A study found that 11.7% of patients with acute ethanol intoxication had abnormal lactate concentrations 3.
• Another study found that the median peak blood lactate level in patients with alcohol-associated lactic acidosis was 15.9 mmol/L 6.
• The mortality rate in patients with alcohol-associated lactic acidosis was 8.7% in one study 6.