Hyperlactatemia and lactate acidosis in the practice of pediatricians

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Abstract

Assessment of blood lactate / lactic acid levels by a General pediatrician is sometimes difficult. Lactate is a product of cellular metabolism of glucose, fatty acids, and some interchangeable amino acids. The norm of lactate in the blood is not defined by international standards, so it depends on the methodology and reagents used in the laboratory. The level of lactate in the blood is the result of an equilibrium between the processes of its formation and utilization. The leading causes of increased blood lactate are anaerobic muscle activity (heavy exercise, seizures), impaired liver and kidney function, lung and heart diseases (respiratory failure, circulatory failure), diabetes, sepsis, regional tissue circulatory disorders (burns and injuries), shocks, some severe abnormalities in the condition of newborns, mitochondrial diseases, and medications. Lactatacidosis is a rare dangerous complication caused by certain pathological conditions (diseases or syndromes), which can end in death. Identification of the cause of lactic acidosis and differential diagnosis of its type is a crucial factor for choosing a treatment strategy. Lactatacidotic coma in diabetes mellitus is a rare, but possible complication, that requires intensive complex treatment in intensive care units. The pediatrician should be able to assess the level of lactate in the blood, analyze the possible causes of hyperlactatemia, and know the algorithm of actions in the development of lactate acidosis.

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About the authors

Natalia V. Parshina

Saint Petersburg State Pediatric Medical University, Ministry of Healthcare of the Russian Federation

Author for correspondence.
Email: duvip@yandex.ru

MD, PhD, Associate Professor, Department of Faculty Pediatrics

Russian Federation, Saint Petersburg

Lyubov A. Danilova

Saint Petersburg State Pediatric Medical University, Ministry of Healthcare of the Russian Federation

Email: lub89@yandex.ru

MD, PhD, Dr. Sci. (Med.), Professor, Head, Department of Biological Chemistry

Russian Federation, Saint Petersburg

Nadezhda S. Dekhtyareva

Saint Petersburg State Pediatric Medical University, Ministry of Healthcare of the Russian Federation

Email: dekhtyaryova.nadezhda@yandex.ru

4th year Student

Russian Federation, Saint Petersburg

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Supplementary files

Supplementary Files
Action
1. Fig. 1. Glucose to lactate Metabolism [8]. NAD – nicotinamide adenine dinucleotide, LDG – lactate dehydrogenase, MCT – monocarboxylic conveyo, AТF – adenosine triphosphate

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2. Fig. 2. Pyruvate-to-lactate conversion reaction [4]

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3. Fig. 3. Glucose-alanine cycle [3]

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4. Fig. 4. Lactate Metabolism in the body [8]

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5. Fig. 5. Glycolysis in muscles and gluconeogenesis in liver (CORI cycle) [9]

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6. Fig. 6. Oxidative decarboxylation of pyruvic acid [3]

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Copyright (c) 2021 Parshina N.V., Danilova L.A., Dekhtyareva N.S.

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