Lactic acid is a microbial metabolite, urinary lactic acid is produced by Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumonia, Enterobacter, Acinetobacter, Proteus mirabilis, Citrobacter frundii, Enterococcus faecalis, Streptococcus group B, Staphylococcus saprophyticus, Bacillus, Corynebacterium, Rhizopus and Saccharomyces cerevisiae. Lactic acid is a good marker distinguishing lower urinary tract infection (cystitis) from upper urinary tract urinary tract infections (pyelonephritis). Excess of exercise, bacterial overgrowth in the GI tract, B-vitamin deficiency have been shown to be contributing factors. The possibility of an inborn error of metabolism increases when the lactic acid value exceeds 300 mmol/mol creatinine. There are many inborn errors of metabolism that are present with elevated lactic acid, including disorders of sugar metabolism, pyruvate dehydrogenase deficiency, and mitochondrial disorders.
Lactate is formed from pyruvate in anaerobic or oxygen starved (hypoxic) circumstances to allow for ongoing production of ATP in these anaerobic conditions. There are no known clinical problems associated with low lactic acid. Low levels are usually a result of reduced amounts of its precursor, pyruvic acid.
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Elevated by a number of nonspeci fic influences, such as vigorous exercise, bacterial overgrowth of the GI tract, shock, poor perfusion, B-vitamin de ciency, mitochondrial dysfunction or damage, and anemia, among others. Tiglylglycine is a more specific indicator of mitochondrial dysfunction or damage. The possibility of an inborn error of metabolism increases when the lactic acid value exceeds 300 mmol/ mol creatinine. There are many inborn errors of metabolism that are present with elevated lactic acid, including disorders of sugar metabolism, pyruvate dehydrogenase de ciency, and mitochondrial disorders.
Possible causes:
- Hypoxia and/or zinc deficiency
- Metabolic stress (e.g. alcohol, toxic metal exposure, or anaemia)
- Possibly insignificant when pyruvic acid is also high
Additional investigations:
- Iron Studies & Red Cell Zinc
- Comprehensive Urine Elements Profile
- Functional Liver Detoxification Profile
Treatment considerations:
If pyruvate NOT high:
- Correct hypoxia
- Remove metabolic stress
- Correct anaemia
- Zn, CoQ10, B2, B3
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2-Hydroxybutyric acid, 2-Hydroxyhippuric acid, 2-Hydroxyisocaproic acid, 2-Hydroxyisovaleric acid, 2-Hydroxyphenylacetic acid, 2-Oxo-4-methiolbutyric acid, 2-Oxoglutaric acid, 2-Oxoisocaproic acid, 2-Oxoisovaleric, 3-Hydroxy-3-methylglutaric, 3-Hydroxybutyric acid, 3-Hydroxyglutaric acid, 3-Indoleacetic acid (IAA), 3-Methyl-2-oxovaleric acid, 3-Methylglutaconic, 3-Methylglutaric acid, 3-Oxoglutaric acid, 4-Cresol, 4-Hydroxybenzoic acid, 4-Hydroxybutyric acid, 4-Hydroxyhippuric acid, 4-Hydroxyphenylacetic acid, 4-Hydroxyphenyllactic acid, 5-Hydroxyindoleacetic acid (5-HIAA), 5-Hydroxymethyl-furoic acid, Acetoacetic acid, Aconitic acid, Adipic acid, Arabinose, Ascorbic acid (Vitamin C), Carboxycitric acid, Citramalic acid, Citric acid, Creatinine, DHPPA (dihydroxyphenylpropionic acid), Dihydroxyphenylacetic acid (DOPAC), Ethylmalonic acid, Fumaric acid, Furan-2,5-dicarboxylic acid, Furancarbonylglycine, GABA, Glutaric acid (Vitamin B2), Glyceric acid, Glycolic acid, Hippuric acid, Homogentisic acid, Homovanillic acid (HVA), HPHPA (3-(3-hydroxyphenyl)-3-hydroxypropionic acid), HVA/DOPAC, HVA/DOPAC Ratio, Kynurenic acid, Lactic acid, Malic acid, Malonic acid, Mandelic acid, Methylcitric acid (Vitamin H), Methylmalonic acid (Vitamin B12), Methylsuccinic acid, N-Acetylaspartic acid, N-Acetylcysteine acid, Orotic acid, Oxalic acid, Pantothenic acid (Vitamin B5), Phenyllactic acid, Phenylpyruvic acid, Phosphoric acid, Pyridoxic acid (Vitamin B6), Pyroglutamic acid, Pyruvic acid, Quinolinic acid, Quinolinic acid/5-HIAA, Sebacic acid, Suberic acid, Succinic acid, Tartaric acid, Thymine, Tricarballyic acid, Uracil
