Thursday, January 30, 2020

How Does Lacate Turn Into Lactic Acid?

You have NO IDEA how much I banged my head against my desk looking for the answer to the question: how does lactate turn into lactic acid? Well, after many hours of searching for an answer, and you can think I'm a dummy for not find the answer sooner or knowing it like a useless fact off of the top of my head, I FOUND IT! It's honestly some information that's not readily available. Many articles play it off and don't mention specifics assuming that "it just happens". I am by no means a biochemist. I'm simply trying to understand all this. In my explanation, I purposefully will be oversimplifying things.

Here's how it works:
In the cytosol, pyruvate turns into lactate (rather than move towards acetyl-CoA) for a number of reasons, again that I'm not going to get into, via lactate dehydrogenase. That lactate (via shuttles) gets to the cytosol of the liver and kidneys where it eventually makes its way into the Cori/Lactic Acid Cycle. The Cori cycle eventually spits out glucose. So far so good, right? Glucose via glycolysis seems to be metabolized into lactate, ATP, and water. Said ATP gets hydrolyzed into ADP and inorganic phosphate which releases that very necessary proton (H+). When conditions get revved up, i.e. septic shock, and an excess of lactate is being produced, then the cell cannot handle the metabolism of lactate and guess what's also being overproduced? Said H+ which tags onto the lactate creating lactic acid.

The articles I've read tend to say that you start running into lactic acidosis territory when you have a lactate >5 with a concurrent acidosis (pH < 7.35). 

Mad props to Amanda, my pharmacist teammate, for listening to me and helping me work through this while not making too much fun of me. 
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Fall P, Szerlip H. Lactic acidosis: from sour milk to septic shock. J Intensive Care Med 2005; 20: 255-71.

Link to article (NOT FREE)

Fall P, Szerlip H. Lactic acidosis: from sour milk to septic shock. J Intensive Care Med 2005; 20: 255-71.

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