内分泌
词汇介绍
拓展阅读
解析
lactic 英 /'læktɪk/ 美 /'læktɪk/
释 义 adj. 乳的；乳汁的
例 句 The somewhat acid flavour is caused by the presence of lactic acid. 这种微酸的味道是因为含有乳酸造成的。
acidosis 英 /,æsɪ'dəʊsɪs/ 美 /,æsɪ'dosɪs/
释 义 n. [内科] 酸中毒，酸毒症；酸液过多症
例 句 Shock , sepsis, acidosis , hypoxia, and so forth, are treated. 对休克，感染，酸中毒，缺氧等应加以治疗。
概述
概述
乳酸性酸中毒是代谢性酸中毒的一种形式，原因是一个人生产过多或未充分利用乳酸，但是他们的身体对乳酸这样的变化却无法适应。乳酸性酸中毒的人的肝脏（有时是肾脏）能够从体内清除多余的酸。如果乳酸在体内积累的速度快于其被清除的速度，那么体液（例如血液）中的酸度水平就会飙升。这种酸的积累会导致人体的pH值失衡，应该始终是弱碱性而不是酸性。有几种不同类型的酸中毒。
当肌肉中的氧气不足以分解葡萄糖和糖原时，就会发生乳酸堆积。这称为无氧代谢。乳酸有两种：L-乳酸和D-乳酸。
病理原因
①心脏病：诸如心脏疾病和充血性心力衰竭之类的状况可能会减少整个身体的血液和氧气流量，这会增加乳酸水平。
②严重感染（败血症）：任何类型的严重病毒或细菌感染都可能导致败血症，败血症患者可能会因氧气流量减少而导致乳酸含量升高。
③HIV：诸如核苷逆转录酶抑制剂之类的艾滋病毒药物会刺激乳酸水平的升高，它们也可能引起肝脏损害，这使身体更难处理乳酸。
④癌症：癌细胞产生乳酸。随着人的体重减轻和疾病进展，这种乳酸的积累可能会加速。
⑤短肠综合征（短肠）：肠道短的人可能会由于小肠细菌过度生长而导致D-乳酸堆积，进行过胃旁路手术的人也可能患有D-乳酸性酸中毒。
⑥对乙酰氨基酚的使用：经常使用对乙酰氨基酚会导致乳酸性酸中毒，即使以正确的剂量服用也是如此。这是因为它会引起焦谷氨酸在血液中的积累。
⑦慢性酒精中毒：长时间过量喝酒会导致乳酸性酸中毒和酒精性酮症酸中毒。如果不加以治疗，酒精性酮症酸中毒是一种潜在的致命疾病，但可以通过静脉内（IV）补液和葡萄糖进行治疗。酒精会增加磷酸盐水平，对肾脏产生负面影响。这使人体的pH值更加酸性。
⑧剧烈运动或体育锻炼：如果身体没有足够的氧气来分解血液中的葡萄糖，那么剧烈的运动可能会导致乳酸暂时堆积。这会在运动的肌肉群中引起灼痛感，还会引起恶心和虚弱。
诊断
禁食血液检查可诊断出乳酸性酸中毒，在测试前8至10个小时不要进食或喝水。可测试前几个小时内限制自己的活动水平。在测试期间，不要握紧拳头，因为这可能会人为地使酸水平升高，在手臂上绑一条松紧带也可能有此结果。由于这些原因，有时通过在手背而不是手臂上找到静脉来进行乳酸酸中毒的血液检查。
治疗
治疗乳酸性酸中毒的最佳方法是治疗其根本原因。因此，治疗方法有所不同。乳酸性酸中毒有时代表医疗急症，这需要治疗症状，无论其根本原因是什么。通常向组织中增加氧气并提供静脉输液以降低乳酸水平。锻炼引起的乳酸性酸中毒可在家中治疗。电解质替代运动饮料，例如佳得乐（Gatorade），有助于水合，但水通常是最好的。
复制标题二甲双胍相关乳酸酸中毒伴急性肾损伤: 一项法国观察性多中心研究结果
发表时间：2019-08-06
影响指数：4.4
作者： Anthony Corchia
期刊：Clin Toxicol
Our study highlights the different mortality rate between MALA and MILA, despite a severe acid–base imbalance in the entire population. We found that shock was strongly associated with death, whereas exposure to RAAS inhibitors surprisingly seemed to have a mild protective effect. Hypotension induced by RAAS inhibitors is generally reversed by intravenous fluid administration. Furthermore, RAAS inhibitors improve left ventricular function in chronic heart failure, reducing cardiac afterload. This may explain their protective effect during shock, especially in MILA. Seventy-five percent of our patients with shock and MALA had septic shock, a condition that was strongly associated with death (data not shown). The assertion that outcome is correlated with lactate levels or pH has yet to be proven. In our cohort, neither lactate levels nor metformin levels were directly associated with death. Selecting a subgroup of 56 cases of severe MALA (pH 10 mmol/L), Kajbaf and Lalau did not confirm this relationship at this level of severity. On the contrary, nadir serum pH, peak serum lactate and metformin concentration were found to be associated with mortality in a systematic review of literature. In our study, metformin level was correlated with lactate level and pH only in MILA (Supplemental Figure S1). Interestingly, there was no correlation in MALA, where LA was mainly influenced by the concurrence of multiple risk factors. This confirms the interest of our approach separating LA according to different situations in a context of metformin exposure. Our study underlines the role of metformin in MILA and refutes arguments that call this pathology into question. MILA is theoretically defined by an increased metformin concentration. We reported 13 patients with a plasma metformin level under 5 mg/L, but we cannot exclude the possibility that this may reflect delayed diagnosis. The time since the last metformin intake was unknown which complicates the interpretation of the plasma level of metformin. Furthermore, exposure to high metformin concentrations may have prolonged effects on oxidative metabolism even after a lengthy washout. The measurement of metformin concentration should be performed as soon as possible even if the results are not immediately available.
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