Normally resulting lactate concentrations are in the range indicated below:
Lactic acidosis is classically defined as an elevated lactate together with pH < 7.35 and bicarbonate below 20 mmol/L, but this is not required as lactic acidosis may exist together with other acid-base abnormalities that may affect these two parameters. Treatment
If elevated lactate is present in acute illness, supporting the oxygen supply and blood flow are key initial steps. Some vasopressors (drugs that augment the blood pressure) are less effective when lactate levels are high, and some agents that stimulate the beta-2 adrenergic receptor can elevate the lactate further.Direct removal of lactate from the body (e.g. with hemofiltration or dialysis) is difficult, with limited evidence for benefit; it may not be possible to keep up with the lactate production.Limited evidence supports the use of sodium bicarbonate solutions to improve the pH (which is associated with increased carbon dioxide generation and may reduce the calcium levels).Lactic acidosis caused by inherited mitochondrial disorders (type B3) may be treated with a ketogenic diet and possibly with dichloroacetate (DCA), although this may be complicated by peripheral neuropathy and has a weak evidence base. Prognosis
Mild and transient elevations in lactate have limited impact on mortality, whereas sustained and severe lactate elevations are associated with a high mortality.The mortality of lactic acidosis in people taking metformin was previously reported to be 50%, but in more recent reports this was closer to 25%. Other animals
Reptiles
Reptiles, which rely primarily on anaerobic energy metabolism (glycolysis) for intense movements, can be particularly susceptible to lactic acidosis.
Omental infarction, or omental torsion, is an acute vascular disorder which compromises tissue of the greater omentum—the largest peritoneal fold in the abdomen. Signs and symptoms
Patients will present with a sudden onset of cramps/abdominal pain or a stitch. The pain localises in the area of the umbilicus and can radiate to the lumbar and surrounding regions. Causes
Omental infarction is a rare cause of acute abdomen pain with reported incidence being less than 4 per 1000 cases of appendicitis. Omental infarction usually presents as right-sided abdominal pain although seldom causing left-sided abdominal pain and even epigastric pain. The dominion of right-sided abdominal pain in omental infarction has been attributed to right segmental infarction as a result of the tenuous blood vessels in this part of the omentum as well as its longer size and higher mobility in comparison to the left side which subjects it to torsion. Obesity is a known risk factor for omental infarction. The theory behind this is that fat accumulation within the omentum occludes blood supply to the distal parts of the omentum in addition to making it more susceptible to torsion. Other risk factors for omental infarction are polycythemia, hypercoagulability, and vasculitides plus other conditions which predispose to torsion such as trauma, sudden body movements, coughing, heavy food intake, and hyperperistalsis.Historically, omental infarction was diagnosed only intraoperatively during surgery for presumed appendicitis or other causes of acute abdomen.