I have read many items about lactic acidosis but I'm still confused. It appears one can have a "low grade" form of this that may cause problems, but not be clinically obvious. I read that testing for serum lactate is a specialized procedure and not yet considered a standard of care. If so, how am I to know whether there is a developing problem that may become more serious? Are carbon dioxide levels a sufficient indicator (seems to me my doctor told me that's how he's monitoring this)? If CO levels are adequate for monitoring, why do we need serum lactate testing? What symptoms would tip me off before the problem, if it occurs, becomes life-threatening? Thanks

Fortunately the rate of lactic acidosis remains low (< 1%) so there is no need to panic. The symptoms are non-specific but can include malaise, nausea, fullness in the stomach, and weakness. A venous lactic acid level sent on ice to a decent lab in the absence of any exercise for many hours beforehand is probably an OK test. The CO levels may pick up more advanced cases but seem unlikely to be any good for screening. More effort is now going into this issue so more answers should be forthcoming over the next year. Keith Henry, M.D.