This is a page discussing the fundamental science behind the production of lactate, as an introduction to the various types of lactic acidosis.

It is a tribute to Dr Kerry Brandis, whose online resource remains a definitive source for the acid-base enthusiast. Other than his works, I have referenced Chapter 15 of Ohs Manual, by Alistair Nichol and D J Cooper.

The Cori cycle

This brief digression into the Cori cycle (named after Carl and Gerty Cori) is to remind us that the body is a constant source of massive amounts of lactate. There is a daily production of roughly 0.8 mmol per kg per hour of lactate each day, about 1500 mmol per day. almost none of which is ever found in one’s bloodstream because of the massive hepatic capacity to complete the metabolic conversion of lactate to glucose.

Cori cycle

Lactate dehydrogenase is the chief enzyme responsible for the conversion of lactate to pyruvate, and pyruvate to lactate. The reaction is very rapid and much of the time it is convenient to view this as an equilibrium.

pyruvate-lactate equation

Intracellularly, the ratio of lactate to pyruvate is maintained at 10 : 1. There is way more lactate than pyruvate.

The lactate has a pKa of 4.0, and so at a physiological pH it is fully dissociated into the lactate conjugate base and a H+ ion. Thus, for every 1 mmol of lactate in the extracellular fluid, one may expect the bicarbonate to decrease by 1 mmol.

There are many origins of lactate. The tissues all seem to share the responsibility for its production while the patient is at rest. Kerry Brandis and Life in the Fast Lane give the following table, as a breakdown of tissues and their relative contribution to the total body lactate production.

Lactate production

Lactate is produced from pyruvate, and  pyruvate is produced by glycolysis (85% of it).

The rate of glycolysis depends on intracellular pH.

Acidosis decreases glycolysis and alkalosis increases it. Thus, in the state of intracellular alkalosis, more pyruvate is produced, which in an oxygen poor environment will be metabolized into lactate instead of being oxidized in the Krebs cycle. This has been demonstrated in studies of the effect of bicarbonate therapy on hypoxic lactic acidosis (turns out, the lactate increases)

Additional notes on the metabolism of lactate and the other "bicarbonate precursors" can be seen here.

References

Narins RG, Krishna GG, Yee J, Idemiyashiro D, Schmidt RJ: The metabolic acidoses. In: Maxwell & Kleeman's Clinical Disorders of Fluid and Electrolyte Metabolism, edited by Narins RG, New York, McGraw-Hill, 1994, pp769 -825

 

Luft FC. Lactic acidosis update for critical care clinicians. J Am Soc Nephrol 2001 Feb; 12 Suppl 17 S15-9.

 

Ohs manual – Chapter 15 by D J (Jamie) Cooper and Alistair D Nichol, titled “Lactic acidosis” (pp. 145)

 

Cohen RD, Woods HF. Lactic acidosis revisited. Diabetes 1983; 32: 181–91.

 

Reichard, George A., et al. "Quantitative estimation of the Cori cycle in the human." Journal of Biological Chemistry 238.2 (1963): 495-501.

 

Andres, Reubin, Gordon Cader, and Kenneth L. Zierler. "The quantitatively minor role of carbohydrate in oxidative metabolism by skeletal muscle in intact man in the basal state. Measurements of oxygen and glucose uptake and carbon dioxide and lactate production in the forearm." Journal of Clinical Investigation 35.6 (1956): 671.

 

Phypers, Barrie, and JM Tom Pierce. "Lactate physiology in health and disease." Continuing Education in Anaesthesia, Critical Care & Pain 6.3 (2006): 128-132.

 

Graf, Helmut, William Leach, and Allen I. Arieff. "Evidence for a detrimental effect of bicarbonate therapy in hypoxic lactic acidosis." Science 227.4688 (1985): 754-756.