Dijagnostički i terapijski pristup bolesniku s laktacidozom

master's thesis

• Title (english): Diagnostics and therapeutic approach to a patient with lactic acidosis
• Author: Paola Blagec
• Mentor: Luka Bielen (mentor)
• Committee member: Radovan Radonić (predsjednik povjerenstva)
• Committee member: Jasenka Markeljević (član povjerenstva)
• Committee member: Luka Bielen (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2021-07-16, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Intensive Care

Abstract

Laktacidoza spada u skupinu metaboličkih acidoza, a javlja se prilikom povećane koncentracije laktata i vodikovih iona u organizmu. Laktat je kiralna molekula koja postoji kao L(+) laktat i D(-) laktat. Pretjerano nakupljanje bilo kojeg od izomera dovodi do nastanka laktacidoze. Kod ljudi se najčešće razvija L-laktacidoza i uglavnom je rezultat neadekvatne tkivne perfuzije i/ili oksigenacije. Uz tkivnu hipoksiju postoje i drugi patofiziološki mehanizmi koji mogu dovesti do razvoja laktacidoze, poput stimulacije aerobne glikolize kateholaminima ili poremećaja provođenja oksidativne fosforilacije. Uzimajući u obzir patofiziološke mehanizme, raznovrsna etiologija laktacidoze podijeljena je u dvije skupine. Prvu skupinu čini laktacidoza tipa A, gdje postoje znakovi koji upućuju na tkivnu hipoksiju, a drugu laktacidoza tipa B, gdje znakova tkivne hipoksije nema. Nerijetko su bolesnici s laktacidozom životno ugroženi, te im je potrebna intenzivna skrb. Klinička slika laktacidoze je nespecifična te ovisi o etiologiji. Unatoč tome, loše opće stanje bolesnika, određeni podaci iz anamneze, te znakovi cirkulacijskog šoka, mogu nagovijestiti kako se radi o bolesniku s laktacidozom. Za postavljenje točne dijagnoze potreban je sistematičan pristup bolesniku, što uključuje detaljnu anamnezu, fizikalni pregled i pretrage poput plinske analize arterijske krvi te mjerenja koncentracije laktata u krvi. Uz navedeno neophodno je i aktivno tragati za primarnim uzrokom. Bolesnik s dijagnosticiranom laktacidozom zahtijeva promptno liječenje, a osnovu terapijskog pristupa čini hemodinamska stabilizacija i adekvatna oksigenacija. Nakon otkrivenog primarnog uzroka laktacidoze, bitno je započeti i sa specifičnim liječenjem. Razumijevanje patofizioloških zbivanja u laktacidozi rezultiralo je i novim lijekovima i idejama o liječenju bolesnika, ali njihovu korist tek je potrebno dokazati.

Abstract (english)

Lactic acidosis is a part of the metabolic acidosis group, appearing in cases of increased concentration of lactates and hydrogen ions in an organism. Lactate is a chiral molecule with two forms – L (+) and D (-) lactate. Accumulation of any of the isomers leads to lactic acidosis. In humans, L-lactic acidosis is more common and is a result of inadequate tissue perfusion and/or inadequate tissue oxygenation. Apart from tissue hypoxia, there are other pathophysiologic mechanisms that may cause lactic acidosis, such as aerobic glycolysis of catecholamines or oxidative phosphorylation conduction disturbance. Considering the pathophysiological mechanisms, the diverse etiology of lactic acidosis is divided into two groups. The first group is type A lactic acidosis, where there is tissue hypoxia, and the second is type B lactic acidosis, where there are no signs of tissue hypoxia. Patients with lactic acidosis are often vitally endangered and need intensive care. The clinical picture of lactic acidosis is nonspecific and depends on the etiology. Nevertheless, the patient's general bad impression, history, and signs pointing to circulatory shock may raise suspicion of lactic acidosis. Further systematic analysis is required for accurate diagnosis – detailed patient history, clinical examination, arterial blood gas analysis and blood lactate levels. Apart from all of the above, an active search for the primary cause is also essential. Patient with diagnosed lactic acidosis requires prompt treatment, based on hemodynamic stabilization and adequate oxygenation. After discovering the primary cause, the specific treatment of the cause is also necessary. The understanding of lactic acidosis' pathophysiology resulted in new medications and ideas of treatment. However, their benefit remains to be proven.

• Keywords: laktacidoza; laktat; vodikovi ioni; šok; dijagnostika; terapija
• Keywords (english): lactic acidosis; lactate; hydrogen ions; shock; diagnosis; therapy
• Language: croatian
• URN:NBN: urn:nbn:hr:105:181040
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2022-01-21 12:12:39