Understanding Elevated Lactic Acid (Hyperlactatemia) and Lactic Acidosis: This resource provides essential information for healthcare professionals on diagnosing, documenting, and coding elevated lactic acid levels. Learn about the causes, symptoms, and treatment of hyperlactatemia, including relevant medical coding terms for accurate clinical documentation and improved patient care. Find key insights for lactic acidosis diagnosis and management.
Also known as
Disorders of acid-base balance
Includes lactic acidosis, a condition with elevated lactic acid.
Other specified abnormal findings of blood chemistry
Can be used for elevated lactic acid if not due to a specific cause.
Myalgia
Muscle pain, sometimes associated with lactic acid buildup.
Follow this step-by-step guide to choose the correct ICD-10 code.
Is the elevated lactic acid due to a drug or toxin?
Yes
Specify the drug or toxin.
No
Is there an underlying medical condition causing the elevated lactic acid?
When to use each related code
| Description |
|---|
| High blood lactic acid levels. |
| High lactic acid due to inadequate tissue oxygenation. |
| Severe lactic acidosis with organ dysfunction. |
Coding lactic acidosis without specifying cause (e.g., sepsis, metformin) can lead to inaccurate severity and reimbursement.
Insufficient documentation of lactic acid levels and related symptoms can cause coding and CDI queries, delaying billing.
Elevated lactic acid can indicate sepsis. Failure to code sepsis when present leads to missed severity and reimbursement.
Q: What are the most common causes of persistent mild to moderate hyperlactatemia in non-critically ill patients?
A: Persistent mild to moderate hyperlactatemia (elevated lactic acid) in non-critically ill patients often presents a diagnostic challenge. While severe elevations typically point to critical conditions like sepsis or shock, milder forms can be attributed to various factors. Common causes include medication side effects (e.g., metformin, nucleoside reverse transcriptase inhibitors), chronic liver disease, underlying genetic disorders affecting mitochondrial function, and vitamin B1 (thiamine) deficiency. Less frequent etiologies encompass conditions like regional hypoperfusion (e.g., limb ischemia), certain cancers (e.g., lymphoma, leukemia), and rare inherited metabolic disorders. A thorough patient history, medication review, and targeted laboratory investigations, including blood gas analysis, liver function tests, and potentially genetic testing, are essential to pinpoint the underlying cause. Consider implementing a stepwise diagnostic approach to differentiate between common and less common causes. Explore how comprehensive metabolic panels can aid in the assessment of hyperlactatemia.
Q: How can I differentiate between lactic acidosis and metformin-associated lactic acidosis (MALA) in a patient with type 2 diabetes?
A: Differentiating between lactic acidosis and metformin-associated lactic acidosis (MALA) in a patient with type 2 diabetes requires careful evaluation. While metformin can contribute to elevated lactic acid levels, it rarely causes clinically significant lactic acidosis. Key differentiating factors include the severity of lactic acidosis, the patient's renal function, and the presence of other contributing factors. MALA is typically associated with markedly elevated lactate levels (>5 mmol/L), significantly impaired renal function (e.g., acute kidney injury), and often coexisting conditions like sepsis or dehydration. In contrast, mild hyperlactatemia in a stable patient with well-controlled diabetes and normal renal function is less likely to be solely attributed to metformin. A thorough review of the patient's medication history, recent illnesses, and assessment of renal function are crucial for accurate diagnosis. Learn more about the clinical guidelines for managing metformin in patients with renal impairment to mitigate the risk of MALA.
Patient presents with signs and symptoms suggestive of elevated lactic acid (hyperlactatemia), potentially indicative of lactic acidosis. Presenting complaints include [Specific patient complaints e.g., fatigue, malaise, nausea, vomiting, abdominal pain, rapid breathing, Kussmaul respirations, altered mental status, hypotension]. On physical examination, the patient exhibited [Specific findings e.g., tachycardia, tachypnea, cool clammy skin]. Initial laboratory workup revealed a significantly elevated serum lactate level of [Insert value] mmolL. Differential diagnosis includes sepsis, hypoperfusion, metformin-associated lactic acidosis (MALA), mitochondrial disorders, thiamine deficiency, severe liver disease, carbon monoxide poisoning, cyanide poisoning, and strenuous exercise. Further investigations are necessary to determine the underlying etiology of the hyperlactatemia. Treatment will be directed at the underlying cause and may include fluid resuscitation, oxygen therapy, and supportive measures to stabilize the patient. Repeat lactate levels will be monitored to assess treatment response. ICD-10 code E87.4 (Other disorders of acid-base balance) is considered pending further diagnostic clarification. CPT codes for laboratory testing (e.g., 82330 for lactate) and other procedures performed will be documented accordingly. Patient education provided regarding the potential causes and implications of lactic acidosis, emphasizing the importance of adherence to the recommended treatment plan and follow-up appointments. Prognosis depends on the underlying cause and the patient's overall health status.